Provider Demographics
NPI:1356355895
Name:HUNT, ROBERT KEITH (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KEITH
Last Name:HUNT
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 J L TODD DR
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-5048
Mailing Address - Country:US
Mailing Address - Phone:706-235-5570
Mailing Address - Fax:706-235-5238
Practice Address - Street 1:2001 J L TODD DR
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-5048
Practice Address - Country:US
Practice Address - Phone:706-235-5570
Practice Address - Fax:706-235-5238
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0101411223S0112X
GA0411411223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00700268FMedicaid
GA00700268FMedicaid
GA19NCBSZMedicare ID - Type Unspecified