Healthcare Provider Details

I. General information

NPI: 1265408785
Provider Name (Legal Business Name): BENJAMIN DALE HUNTER II DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 GRUNNION AVE BRANCH DENTAL CLINIC
GROTON CT
06349-5050
US

IV. Provider business mailing address

NAVAL AMBULATORY CARE CENTER ROUTE 12, BLDG 449, ATTN: PROFESSIONAL AFFAIRS
GROTON CT
06349-5600
US

V. Phone/Fax

Practice location:
  • Phone: 860-694-2377
  • Fax: 860-694-2590
Mailing address:
  • Phone: 860-694-2377
  • Fax: 860-694-2590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number15048
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: