Healthcare Provider Details

I. General information

NPI: 1164351805
Provider Name (Legal Business Name): HUNTER KORTUM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 US-190 STE 100
COVINGTON LA
70433
US

IV. Provider business mailing address

5325 FULVETTA FALLS RD
SLIDELL LA
70461-5242
US

V. Phone/Fax

Practice location:
  • Phone: 985-718-1439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7791
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: