Provider Demographics
NPI:1659000941
Name:HUNT, MALLORY MICHELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:MICHELLE
Last Name:HUNT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 LAKE VISTA CT APT 209
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-6470
Mailing Address - Country:US
Mailing Address - Phone:813-317-6058
Mailing Address - Fax:
Practice Address - Street 1:5744 CANTON CV
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5034
Practice Address - Country:US
Practice Address - Phone:407-699-9831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0007035-C1122300000X
FL27669122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist