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Individual

MR. JOHN ROBERT HALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
1004 OAK DRIVE, RICHMOND, IN 47374
(765) 935-1997
Mailing address
3063 DOGWOOD LN, RICHMOND, IN 47374-3530
(765) 935-3073

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12006602
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000083630
ANTHEM ID NUMBER
IN
05
100354300A
IN
Enumeration date
08/19/2005
Last updated
07/09/2014
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