Individual
DR. GARY WAYNE HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
908 PALM BLVD S, NICEVILLE, FL 32578-2603
(850) 729-1223
(850) 678-6086
Mailing address
908 PALM BLVD S, NICEVILLE, FL 32578-2603
(850) 729-1223
(850) 678-6086
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN0012157
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
64709
BLUE CROSS OF FLORIDA
FL
01
—
809857
UNITED CONCORDIA
—
Enumeration date
08/29/2006
Last updated
07/08/2007
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