Provider Demographics
NPI:1710193255
Name:HUNSAKER, BRIAN EDDIE (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:EDDIE
Last Name:HUNSAKER
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 1:3032 HUNTERS COVE
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-4952
Mailing Address - Country:US
Mailing Address - Phone:307-362-7671
Mailing Address - Fax:
Practice Address - Street 1:550 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-6346
Practice Address - Country:US
Practice Address - Phone:307-362-7671
Practice Address - Fax:307-362-1163
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice