Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 12494 | MI |
NPI | 1164565065 |
---|---|
Provider Name | Dr. Robert M Hale |
First Address | Davison, MI 48423-2002 |
Second Address | Davison, MI 48423-2002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 08/07/2007 |