Provider Demographics
NPI:1063257848
Name:PRINCE, HUNTER SHANE (DMD)
Entity type:Individual
Prefix:DR
First Name:HUNTER
Middle Name:SHANE
Last Name:PRINCE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 PO BOX
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-9995
Mailing Address - Country:US
Mailing Address - Phone:606-465-2317
Mailing Address - Fax:
Practice Address - Street 1:1605 13TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-3509
Practice Address - Country:US
Practice Address - Phone:606-329-0459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist