Provider Demographics
NPI:1194722892
Name:HALL, MICHAEL CURTIS (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CURTIS
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 1:2952 LAZY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8182
Mailing Address - Country:US
Mailing Address - Phone:541-779-3324
Mailing Address - Fax:541-779-3357
Practice Address - Street 1:2952 LAZY CREEK DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8182
Practice Address - Country:US
Practice Address - Phone:541-779-3324
Practice Address - Fax:541-779-3357
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD74861223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics