=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174610869
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R. BERYL HUNTER, D.M.D., M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10219 S PARK GLENN WAY STE 201
-----------------------------------------------------
City | PARKER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80138-3875
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-840-7400
-----------------------------------------------------
Fax | 303-840-7478
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10219 PARKGLENN WAY SUITE 201
-----------------------------------------------------
City | PARKER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80138-3875
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-840-7400
-----------------------------------------------------
Fax | 303-840-7478
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR/OWNER
-----------------------------------------------------
Name | DR. R. BERYL HUNTER
-----------------------------------------------------
Credential | D.M.D., M.D.
-----------------------------------------------------
Telephone | 303-840-7400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------