Healthcare Provider Details

I. General information

NPI: 1205762473
Provider Name (Legal Business Name): SAMANTHA MARIE HUNTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 S 6TH ST
COUNCIL BLUFFS IA
51501-6441
US

IV. Provider business mailing address

9009 BUCKSHOT RD
LINCOLN NE
68507-1230
US

V. Phone/Fax

Practice location:
  • Phone: 712-325-1990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDDS-10488
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS-10488
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: