Provider Demographics
NPI:1992997555
Name:HALL, STANTON HARRIS (DDS MS PHD)
Entity type:Individual
Prefix:
First Name:STANTON
Middle Name:HARRIS
Last Name:HALL
Suffix:
Gender:M
Credentials:DDS MS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12817 120TH AVE NE
Mailing Address - Street 2:SUITE D
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-821-7888
Mailing Address - Fax:425-821-0412
Practice Address - Street 1:12817 120TH AVE NE
Practice Address - Street 2:SUITE D
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-821-7888
Practice Address - Fax:425-821-0412
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA51711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics