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General NPI Number Information
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NPI Number | 1104710755
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Entity Type | Individual
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Provider Name | CARSON THEODORE HUNT DDS
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Gender | Male
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 4076 3RD AVE STE 201
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City | SAN DIEGO
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State | CA
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Zip | 92103-2129
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Country | US
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Telephone | 619-298-2322
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Fax |
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Provider Business Mailing Address
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Address Line | 2469 PURDUE AVE APT 203
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City | LOS ANGELES
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State | CA
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Zip | 90064-5111
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Country | US
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Telephone | 530-966-1745
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 111448
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License Number State | CA
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