=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295158947
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOUGLAS B HUNT PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2014
-----------------------------------------------------
Last Update Date | 01/31/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22711 S ELLSWORTH RD
-----------------------------------------------------
City | QUEEN CREEK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85142-6788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-325-7639
-----------------------------------------------------
Fax | 480-216-8699
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22711 S ELLSWORTH RD
-----------------------------------------------------
City | QUEEN CREEK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85142-6788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-325-7639
-----------------------------------------------------
Fax | 480-216-8699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MR. DOUGLAS BRIAN HUNT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-650-2486
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 4913
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------