Healthcare Provider Details

I. General information

NPI: 1689601015
Provider Name (Legal Business Name): MARK HAYS HURST DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 HEALTH PARK DR
MENA AR
71953-9072
US

IV. Provider business mailing address

PO BOX 1848
MENA AR
71953-1841
US

V. Phone/Fax

Practice location:
  • Phone: 479-437-3449
  • Fax: 479-243-0285
Mailing address:
  • Phone: 479-437-3449
  • Fax: 479-243-0285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3324
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: