Healthcare Provider Details

I. General information

NPI: 1023425204
Provider Name (Legal Business Name): TIMOTHY HURLEY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2014
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 PLACER ST
REDDING CA
96001-1125
US

IV. Provider business mailing address

1035 PLACER ST
REDDING CA
96001-1125
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-5710
  • Fax: 530-245-0863
Mailing address:
  • Phone: 530-246-5710
  • Fax: 530-245-0863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number057921-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: