Provider Demographics
NPI:1043364540
Name:HUNTER, MARY LOUISE (RDA)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:LOUISE
Last Name:HUNTER
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 STOCKTON BLVD
Mailing Address - Street 2:ROOM 5200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2207
Mailing Address - Country:US
Mailing Address - Phone:916-734-5408
Mailing Address - Fax:916-734-4960
Practice Address - Street 1:2521 STOCKTON BLVD
Practice Address - Street 2:ROOM 5200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2207
Practice Address - Country:US
Practice Address - Phone:916-734-5408
Practice Address - Fax:916-734-4960
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31341126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant