Provider Demographics
NPI:1871606376
Name:HALL, RICHARD EVERETT (DDS, MD, PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EVERETT
Last Name:HALL
Suffix:
Gender:M
Credentials:DDS, MD, PHD
Other - Prefix:
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Mailing Address - Street 1:3435 MAIN ST
Mailing Address - Street 2:112 SQUIRE HALL, BUILDING 32
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-3001
Mailing Address - Country:US
Mailing Address - Phone:716-829-6637
Mailing Address - Fax:716-829-3019
Practice Address - Street 1:3435 MAIN ST
Practice Address - Street 2:112 SQUIRE HALL, BUILDING 32
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-3001
Practice Address - Country:US
Practice Address - Phone:716-829-6637
Practice Address - Fax:716-829-3019
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0358071223S0112X
NY197678204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00840235Medicaid