Healthcare Provider Details

I. General information

NPI: 1962961094
Provider Name (Legal Business Name): MATTHEW HURD PHD, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 FOLSOM ST
SAN FRANCISCO CA
94105-3172
US

IV. Provider business mailing address

450 FOLSOM ST APT 1702
SAN FRANCISCO CA
94105-3373
US

V. Phone/Fax

Practice location:
  • Phone: 310-868-4488
  • Fax:
Mailing address:
  • Phone: 310-868-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberDDS104217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: