Provider Demographics
NPI:1629261789
Name:HUNT, DOUGLAS BRIAN (DDS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:BRIAN
Last Name:HUNT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22711 S. ELLSWORTH ROAD SUITE #101
Mailing Address - Street 2:22711 S. ELLSWORTH ROAD SUITE #101
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142
Mailing Address - Country:US
Mailing Address - Phone:480-219-8559
Mailing Address - Fax:480-219-8611
Practice Address - Street 1:22711 S. ELLSWORTH ROAD SUITE #101
Practice Address - Street 2:22711 S. ELLSWORTH ROAD SUITE #101
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142
Practice Address - Country:US
Practice Address - Phone:480-219-8559
Practice Address - Fax:480-219-8611
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4913122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist