Provider Demographics
NPI:1063709160
Name:HUNZINGER, MICHAEL JARED (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JARED
Last Name:HUNZINGER
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 1:5551 SUNSET BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9132
Mailing Address - Country:US
Mailing Address - Phone:803-399-8829
Mailing Address - Fax:803-520-0752
Practice Address - Street 1:5551 SUNSET BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9132
Practice Address - Country:US
Practice Address - Phone:803-399-8829
Practice Address - Fax:803-520-0752
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-09
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC87201223G0001X
KY90701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice