Provider Demographics
NPI:1093935744
Name:HUNTLEY, MICHAEL H (DDS,PLLC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:HUNTLEY
Suffix:
Gender:M
Credentials:DDS,PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 OLD MILITARY RD NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3241
Mailing Address - Country:US
Mailing Address - Phone:360-692-4705
Mailing Address - Fax:360-692-4846
Practice Address - Street 1:7500 OLD MILITARY RD NE
Practice Address - Street 2:SUITE 201
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3241
Practice Address - Country:US
Practice Address - Phone:360-692-4705
Practice Address - Fax:360-692-4846
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA59391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice