Provider Demographics
NPI:1710080718
Name:HUNTRESS, GORDON PALMER (DDS)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:PALMER
Last Name:HUNTRESS
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 1:222 PIEDMONT AVE
Mailing Address - Street 2:SUITE 8300
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:513-475-7991
Mailing Address - Fax:513-475-7996
Practice Address - Street 1:222 PIEDMONT AVE
Practice Address - Street 2:SUITE 8300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-475-7991
Practice Address - Fax:513-475-7996
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAH67875831223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0243758Medicaid
OH0243758Medicaid
OHHU0400202Medicare ID - Type Unspecified