Provider Demographics
NPI:1396138731
Name:DR. MATTHEW HALL, PC
Entity type:Organization
Organization Name:DR. MATTHEW HALL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:9164-451-0407
Mailing Address - Street 1:791 EL DORADO WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3214
Mailing Address - Country:US
Mailing Address - Phone:916-451-0407
Mailing Address - Fax:
Practice Address - Street 1:791 EL DORADO WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3214
Practice Address - Country:US
Practice Address - Phone:916-451-0407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62490261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental