Provider Demographics
NPI:1093189763
Name:HUNT FAMILY DENTAL
Entity Type:Organization
Organization Name:HUNT FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-752-1920
Mailing Address - Street 1:203 NE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4821
Mailing Address - Country:US
Mailing Address - Phone:503-472-8802
Mailing Address - Fax:
Practice Address - Street 1:203 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4821
Practice Address - Country:US
Practice Address - Phone:503-472-8802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORB90141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty