Provider Demographics
NPI:1437370988
Name:HUNT, KYLE TANNER (DMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:TANNER
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 1:971 LAKELAND DR STE 952
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4609
Mailing Address - Country:US
Mailing Address - Phone:601-981-3111
Mailing Address - Fax:601-981-3112
Practice Address - Street 1:971 LAKELAND DR STE 952
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4609
Practice Address - Country:US
Practice Address - Phone:601-981-3111
Practice Address - Fax:601-981-3112
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3374-061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I191017OtherPTAN MEDICARE NUMBER