Provider Demographics
NPI:1174650238
Name:HUNTER, GAINES MARION (DDS)
Entity Type:Individual
Prefix:DR
First Name:GAINES
Middle Name:MARION
Last Name:HUNTER
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 1:1011 W FRIENDLY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1862
Mailing Address - Country:US
Mailing Address - Phone:336-274-6073
Mailing Address - Fax:336-272-7807
Practice Address - Street 1:1011 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1862
Practice Address - Country:US
Practice Address - Phone:336-274-6073
Practice Address - Fax:336-272-7807
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC48531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8994328Medicaid
NC94328OtherBLUE CROSS BLUE SHIELD