Organization
HALES DENTAL PRACTICE, PC
Active
Other names
Angellift Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIM B HALES DDS (DENTIST/OWNER)
(541) 474-1100
Entity
Organization
Contact information
Practice address
781 NE 7TH ST, B, GRANTS PASS, OR 97526-1654
(541) 474-1100
(541) 474-1103
Mailing address
781 NE 7TH ST, B, GRANTS PASS, OR 97526-1654
(541) 474-1100
(541) 474-1103
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D6777
OR
305S00000X
Point of Service
D6777
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040241
—
OR
01
—
6080140001
MEDICARE DME PTAN
OR
Enumeration date
12/15/2016
Last updated
12/15/2016
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