Provider Demographics
NPI:1194942383
Name:HUNTER, IRENE FERN (DDS)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:FERN
Last Name:HUNTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7211 LIGHTHOUSE LN NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-9206
Mailing Address - Country:US
Mailing Address - Phone:360-704-7293
Mailing Address - Fax:360-264-2353
Practice Address - Street 1:872 SUSSEX AVE E
Practice Address - Street 2:
Practice Address - City:TENINO
Practice Address - State:WA
Practice Address - Zip Code:98589-9287
Practice Address - Country:US
Practice Address - Phone:360-264-2353
Practice Address - Fax:360-264-6374
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000060011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0188OtherWASHINGTON DENTAL SERVICE
WAHU1123OtherREGENCE INSURANCE
WA5046828Medicaid