Healthcare Provider Details

I. General information

NPI: 1144359092
Provider Name (Legal Business Name): RANDY STEVEN HURLEY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 W IRON SPRINGS RD SUITE F
PRESCOTT AZ
86305-1614
US

IV. Provider business mailing address

1151 W IRON SPRINGS RD SUITE F
PRESCOTT AZ
86305-1614
US

V. Phone/Fax

Practice location:
  • Phone: 928-771-2526
  • Fax: 928-777-2469
Mailing address:
  • Phone: 928-771-2526
  • Fax: 928-777-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4339
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: