Provider Demographics
NPI:1952157836
Name:BARROSO, HUNTER
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:
Last Name:BARROSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 GEORGIA AVE NW APT 429
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20059-1014
Mailing Address - Country:US
Mailing Address - Phone:832-243-2643
Mailing Address - Fax:
Practice Address - Street 1:21690 US HWY 59, STE 100 NEW CANEY, TX 77357
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357
Practice Address - Country:US
Practice Address - Phone:281-747-3147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX40574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program