Provider Demographics
NPI:1730441221
Name:HALL, DEVIN T (DMD)
Entity type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:T
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 1:1433 RIVA RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7617
Mailing Address - Country:US
Mailing Address - Phone:270-556-6221
Mailing Address - Fax:
Practice Address - Street 1:1857 TUCKER WAY
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-6258
Practice Address - Country:US
Practice Address - Phone:270-781-2952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9176122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist