Individual
LISA D HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
60 CENTER ST, BEATTYVILLE, KY 41311-9085
(606) 464-9262
(066) 208-8122
Mailing address
PO BOX 690, BEATTYVILLE, KY 41311-0690
(606) 464-0151
(606) 464-0151
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6568
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31000862
MEDICAID FQHC
KY
05
—
60065687
—
KY
01
—
6568
KY LICENSE KENTUCKY DENTA
KY
Enumeration date
04/02/2007
Last updated
03/15/2024
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