Provider Demographics
NPI:1083763734
Name:HUNTSMAN, JAMES MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARK
Last Name:HUNTSMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-1120
Mailing Address - Country:US
Mailing Address - Phone:270-237-3655
Mailing Address - Fax:270-237-3278
Practice Address - Street 1:199 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-1120
Practice Address - Country:US
Practice Address - Phone:270-237-3655
Practice Address - Fax:270-237-3278
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist