Provider Demographics
NPI:1487997474
Name:TIM E HUNT DDS PA
Entity type:Organization
Organization Name:TIM E HUNT DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-839-2273
Mailing Address - Street 1:439 N CENTENNIAL AVE
Mailing Address - Street 2:P. O. BOX 760
Mailing Address - City:WEST FORK
Mailing Address - State:AR
Mailing Address - Zip Code:72774-2708
Mailing Address - Country:US
Mailing Address - Phone:479-839-2273
Mailing Address - Fax:479-839-2274
Practice Address - Street 1:439 N CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:WEST FORK
Practice Address - State:AR
Practice Address - Zip Code:72774-2708
Practice Address - Country:US
Practice Address - Phone:479-839-2273
Practice Address - Fax:479-839-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty