Provider Demographics
NPI:1316165996
Name:HALL, STEVEN MAURICE (DMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MAURICE
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 1:252 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6431
Mailing Address - Country:US
Mailing Address - Phone:407-365-1242
Mailing Address - Fax:407-365-4998
Practice Address - Street 1:252 PLAZA DR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6431
Practice Address - Country:US
Practice Address - Phone:407-365-1242
Practice Address - Fax:407-365-4998
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 109151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice