Provider Demographics
NPI:1154851681
Name:HALL, KASEY (DMD)
Entity type:Individual
Prefix:DR
First Name:KASEY
Middle Name:
Last Name:HALL
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14210 SE SUNNYSIDE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5241
Mailing Address - Country:US
Mailing Address - Phone:971-645-2555
Mailing Address - Fax:
Practice Address - Street 1:14210 SE SUNNYSIDE RD STE 100
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5241
Practice Address - Country:US
Practice Address - Phone:503-658-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33334122300000X
ORD119681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist