Provider Demographics
NPI:1144846890
Name:HALL, JON E (DMD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:E
Last Name:HALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8265 S HOUGHTON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5766
Mailing Address - Country:US
Mailing Address - Phone:520-663-0419
Mailing Address - Fax:520-663-0429
Practice Address - Street 1:2312 N ROSEMONT BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6114
Practice Address - Country:US
Practice Address - Phone:520-663-0419
Practice Address - Fax:520-663-0429
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD107011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice