Provider Demographics
NPI:1053547042
Name:HALL, JEFFREY DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DAVID
Last Name:HALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-4246
Mailing Address - Country:US
Mailing Address - Phone:828-248-9100
Mailing Address - Fax:828-248-2276
Practice Address - Street 1:621 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-4246
Practice Address - Country:US
Practice Address - Phone:828-248-9100
Practice Address - Fax:828-248-2276
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice