Provider Demographics
NPI:1407041452
Name:HUNT, RYAN LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LEE
Last Name:HUNT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 LOUISVILLE BOATDOCK RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-3709
Mailing Address - Country:US
Mailing Address - Phone:503-939-2753
Mailing Address - Fax:
Practice Address - Street 1:109 S CAMPBELL STATION RD
Practice Address - Street 2:
Practice Address - City:FARRAGUT
Practice Address - State:TN
Practice Address - Zip Code:37934-2845
Practice Address - Country:US
Practice Address - Phone:503-939-2753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9014122300000X
TN0000011234122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist