Healthcare Provider Details

I. General information

NPI: 1407805427
Provider Name (Legal Business Name): DOUGLAS EDWARD HUNTER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 NOLENSVILLE PIKE
NASHVILLE TN
37211-5411
US

IV. Provider business mailing address

4905 NOLENSVILLE PIKE
NASHVILLE TN
37211-5411
US

V. Phone/Fax

Practice location:
  • Phone: 615-832-4979
  • Fax: 615-832-4910
Mailing address:
  • Phone: 615-832-4979
  • Fax: 615-832-4910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS3692
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: