Provider Demographics
NPI:1811283518
Name:HUNTER C. JOH, DDS PA
Entity type:Organization
Organization Name:HUNTER C. JOH, DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUNTER
Authorized Official - Middle Name:CROOM
Authorized Official - Last Name:JOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-352-3161
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28349-0826
Mailing Address - Country:US
Mailing Address - Phone:910-352-3161
Mailing Address - Fax:
Practice Address - Street 1:123 BRYAN STREET
Practice Address - Street 2:
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349-0826
Practice Address - Country:US
Practice Address - Phone:910-352-3161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86881223G0001X
NC72931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902JWMedicaid