=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841257011
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID R HUNTER, D.D.S., PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6525 W SACK DR SUITE 101
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85308-7104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-566-4800
-----------------------------------------------------
Fax | 623-566-4605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6525 W SACK DR SUITE 101
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85308-7104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-566-4800
-----------------------------------------------------
Fax | 623-566-4605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. DAVID R HUNTER
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 623-566-4800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 3541
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------