Healthcare Provider Details

I. General information

NPI: 1467674424
Provider Name (Legal Business Name): MARK STEPHEN HUNTER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 N CENTER ST # 101
NORTHVILLE MI
48167-1486
US

IV. Provider business mailing address

149 N CENTER ST # 101
NORTHVILLE MI
48167-1486
US

V. Phone/Fax

Practice location:
  • Phone: 248-449-1677
  • Fax:
Mailing address:
  • Phone: 248-449-1677
  • Fax: 248-449-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number15772
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: