Provider Demographics
NPI:1699119529
Name:HUNSICKER, GRANT OSCAR (DDS)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:OSCAR
Last Name:HUNSICKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9978 BEVERLY LN
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-4986
Mailing Address - Country:US
Mailing Address - Phone:330-730-4454
Mailing Address - Fax:
Practice Address - Street 1:150 WEST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2296
Practice Address - Country:US
Practice Address - Phone:330-730-4454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0237401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice