Healthcare Provider Details

I. General information

NPI: 1215863105
Provider Name (Legal Business Name): DAX HUNTER HURST DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 OLD GREENSBORO RD STE D
JONESBORO AR
72405-2076
US

IV. Provider business mailing address

115 ISLE CREEK DR
MEMPHIS TN
38103-9000
US

V. Phone/Fax

Practice location:
  • Phone: 870-333-1352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4941
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: