Provider Demographics
NPI:1336110055
Name:KENNETH M HUNTER DDS, JILL H HUNTER DDS, APC
Entity Type:Organization
Organization Name:KENNETH M HUNTER DDS, JILL H HUNTER DDS, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:H
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-448-6882
Mailing Address - Street 1:292 ALAMO DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4243
Mailing Address - Country:US
Mailing Address - Phone:707-448-6882
Mailing Address - Fax:707-448-9703
Practice Address - Street 1:292 ALAMO DR
Practice Address - Street 2:SUITE 5
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4243
Practice Address - Country:US
Practice Address - Phone:707-448-6882
Practice Address - Fax:707-448-9703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA196331223G0001X
CA252641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty