Provider Demographics
NPI:1154501633
Name:HUNTER, MARY ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:HUNTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:CLIETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:14747 BLACK CHERRY TRL
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-6275
Mailing Address - Country:US
Mailing Address - Phone:513-515-1634
Mailing Address - Fax:407-395-4022
Practice Address - Street 1:10658 AVALON RD STE 100
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-6953
Practice Address - Country:US
Practice Address - Phone:407-347-4071
Practice Address - Fax:407-395-4022
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30022609122300000X, 1223G0001X
FLDN23934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFC1929984OtherDEA