MEDICARE: DR. ROBERT CLARK HALL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1002145-15	WI

General Provider Information

NPI Number	:	1770145609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT CLARK HALL DDS

Provider Business Mailing Address
First Line	:	3555 S KINNICKINNIC AVE
Second Line	:
City	:	SAINT FRANCIS
State	:	WI
Zip	:	53235-3739
Country	:	US
Telephone Number	:	414-744-0634
Fax Number	:

Provider Business Practice Location Address
First Line	:	3555 S KINNICKINNIC AVE
Second Line	:
City	:	ST FRANCIS
State	:	WI
Zip	:	53235-3739
Country	:	US
Telephone Number	:	414-744-0634
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	07/17/2023

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