Provider Demographics
NPI:1497818389
Name:HUNT, JOHNNIE L (DDS)
Entity Type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:L
Last Name:HUNT
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 1:9804 BLUEBONNET BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-6442
Mailing Address - Country:US
Mailing Address - Phone:225-769-1969
Mailing Address - Fax:225-769-1970
Practice Address - Street 1:9804 BLUEBONNET BLVD STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-6442
Practice Address - Country:US
Practice Address - Phone:225-769-1969
Practice Address - Fax:225-769-1970
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA52491223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1852490Medicaid