MEDICARE: TERESA HALL DDS INC

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	122300000X	Dentist
2	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1972956902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERESA HALL DDS INC

Provider Business Mailing Address
First Line	:	953 PLEASANT GROVE BLVD
Second Line	:	STE 140
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-6150
Country	:	US
Telephone Number	:	916-772-6248
Fax Number	:

Provider Business Practice Location Address
First Line	:	953 PLEASANT GROVE BLVD
Second Line	:	STE 140
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-6150
Country	:	US
Telephone Number	:	916-772-6248
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TERESA HALL
Credential	:	DDS
Telephone Number	:	916-772-6248

Provider Enumeration Date	:	07/14/2016
Last Update Date	:	07/14/2016

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