Provider Demographics
NPI:1326323270
Name:HUNTER, GREGORY BEAU
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:BEAU
Last Name:HUNTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 ADMIRAL LN
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-8214
Mailing Address - Country:US
Mailing Address - Phone:530-966-5869
Mailing Address - Fax:
Practice Address - Street 1:7072 SKYWAY
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3940
Practice Address - Country:US
Practice Address - Phone:530-966-5869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA604381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice