Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 8469 | CO |
NPI | 1003933847 |
---|---|
Provider Name | Dwayne Preston Hall |
First Address | Colorado Springs, CO 80918-5623 |
Second Address | Colorado Springs, CO 80922-2504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2007 |
Last Update Date | 27/08/2007 |