Provider Demographics
NPI:1477587988
Name:HUNTLEY, JOHN DOUGLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:HUNTLEY
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 1:28 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-1536
Mailing Address - Country:US
Mailing Address - Phone:603-752-9299
Mailing Address - Fax:
Practice Address - Street 1:364 PRITHAM AVE
Practice Address - Street 2:CA DEAN MEMORIAL HOSPITAL
Practice Address - City:GREENVILLE
Practice Address - State:ME
Practice Address - Zip Code:04441
Practice Address - Country:US
Practice Address - Phone:207-695-3767
Practice Address - Fax:207-695-3826
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME34131223G0001X
NH26211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice