Healthcare Provider Details

I. General information

NPI: 1053110684
Provider Name (Legal Business Name): HUNTER MISSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7017 PERKINS RD
BATON ROUGE LA
70808-4320
US

IV. Provider business mailing address

3644 SIERRA CIR
SULPHUR LA
70665-7201
US

V. Phone/Fax

Practice location:
  • Phone: 225-277-3311
  • Fax:
Mailing address:
  • Phone: 337-377-4046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7691
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: