Healthcare Provider Details

I. General information

NPI: 1568986511
Provider Name (Legal Business Name): HURST FAMILY DENTAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 E POINTER TRL
VAN BUREN AR
72956-2317
US

IV. Provider business mailing address

PO BOX 819
VAN BUREN AR
72957-0819
US

V. Phone/Fax

Practice location:
  • Phone: 479-474-1972
  • Fax:
Mailing address:
  • Phone: 479-461-7811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3324
License Number StateAR

VIII. Authorized Official

Name: DR. MARK HAYS HURST
Title or Position: PRESIDENT
Credential: DDS
Phone: 479-474-1972