Provider Demographics
NPI:1346239316
Name:HUNTER, SUSMITA REGULUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSMITA
Middle Name:REGULUS
Last Name:HUNTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603-1415
Mailing Address - Country:US
Mailing Address - Phone:718-771-1874
Mailing Address - Fax:
Practice Address - Street 1:1324 BERGEN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1530
Practice Address - Country:US
Practice Address - Phone:718-771-1874
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0406691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01028931Medicaid