Healthcare Provider Details

I. General information

NPI: 1356331359
Provider Name (Legal Business Name): HERMAN ELDON HURD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 COUNTRY CLUB RD
SHERWOOD AR
72120-5076
US

IV. Provider business mailing address

1513 COUNTRY CLUB RD
SHERWOOD AR
72120-5076
US

V. Phone/Fax

Practice location:
  • Phone: 501-992-1640
  • Fax: 501-992-1641
Mailing address:
  • Phone: 501-992-1640
  • Fax: 501-992-1641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2021
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: