Provider Demographics
NPI:1730171836
Name:HALES, KENT A (DDS)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:A
Last Name:HALES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 E FRY BLVD
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2602
Mailing Address - Country:US
Mailing Address - Phone:520-458-9460
Mailing Address - Fax:520-458-9461
Practice Address - Street 1:1236 E FRY BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2602
Practice Address - Country:US
Practice Address - Phone:520-458-9460
Practice Address - Fax:520-458-9461
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
AZAZ 4943122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist