Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 007780 | CT |
NPI | 1700044542 |
---|---|
Provider Name | Dr. Kevin Allan Hall |
First Address | Hartford, CT 06145-2094 |
Second Address | Hartford, CT 06114-1780 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2008 |
Last Update Date | 29/05/2008 |