MEDICARE: EDWINA F. HUNTER D.D.S.

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	1223G0001X	General Practice Dentistry	2279	AR

General Provider Information

NPI Number	:	1720296981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWINA F. HUNTER D.D.S.

Provider Business Mailing Address
First Line	:	481 N WASHINGTON AVE
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-5615
Country	:	US
Telephone Number	:	870-863-3640
Fax Number	:	870-863-4430

Provider Business Practice Location Address
First Line	:	481 N WASHINGTON AVE
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-5615
Country	:	US
Telephone Number	:	870-863-3640
Fax Number	:	870-863-4430

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

Provider Enumeration Date	:	05/20/2007
Last Update Date	:	07/08/2007

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