MEDICARE: MS. COLLEENA HUNT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	126800000X	Dental Assistant

General Provider Information

NPI Number	:	1134580194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COLLEENA HUNT

Provider Business Mailing Address
First Line	:	7914 LUMBER JACK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-1741
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7914 LUMBER JACK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-1741
Country	:	US
Telephone Number	:	281-630-1807
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2016
Last Update Date	:	03/17/2016

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