Individual
LAURA L HALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2020
(503) 879-2071
Mailing address
608 LA JOYA ST STE B, ESPANOLA, NM 87532-3467
(505) 753-9454
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
08516
IA
122300000X
Dentist
Primary
D11922
OR
122300000X
Dentist
DD3192
NM
1223G0001X
General Practice Dentistry
6648
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0723403
—
IA
05
—
10025408800
—
NE
01
—
1883524
UNITED CONCORDIA
NE
Enumeration date
11/22/2006
Last updated
12/13/2023
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