Provider Demographics
NPI:1083708952
Name:HUNT, KENLEY HILDEBRAND (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENLEY
Middle Name:HILDEBRAND
Last Name:HUNT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 E BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5155
Mailing Address - Country:US
Mailing Address - Phone:714-529-4477
Mailing Address - Fax:714-529-7031
Practice Address - Street 1:1220 EAST BIRCH ST
Practice Address - Street 2:102
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5155
Practice Address - Country:US
Practice Address - Phone:714-529-4477
Practice Address - Fax:714-529-7031
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAH21722122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist