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General NPI Number Information
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NPI Number | 1811283518
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Entity Type | Organization
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Legal Business Name | HUNTER C. JOH, DDS PA
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 06/22/2011
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Provider Practice Location Address
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Address Line | 123 BRYAN STREET
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City | KENANSVILLE
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State | NC
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Zip | 28349-0826
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Country | US
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Telephone | 910-352-3161
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 826
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City | KENANSVILLE
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State | NC
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Zip | 28349-0826
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Country | US
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Telephone | 910-352-3161
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HUNTER CROOM JOH
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Credential | DDS
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Telephone | 910-352-3161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8688
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7293
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License Number State | NC
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