Provider Demographics
NPI:1306387469
Name:HUNTERS VILLAGE DENTAL
Entity Type:Organization
Organization Name:HUNTERS VILLAGE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WUENSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-629-9000
Mailing Address - Street 1:245 HUNTERS VILLAGE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132
Mailing Address - Country:US
Mailing Address - Phone:830-629-9000
Mailing Address - Fax:830-629-0299
Practice Address - Street 1:245 HUNTERS VILLAGE PARKWAY
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132
Practice Address - Country:US
Practice Address - Phone:830-629-9000
Practice Address - Fax:830-629-0299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUNTERS VILLAGE DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14594261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1225257033OtherNPI
TX14594OtherLICENSE