Healthcare Provider Details

I. General information

NPI: 1063534857
Provider Name (Legal Business Name): AUTUMN G HURD D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 E MINERAL AVE STE A
LITTLETON CO
80122-2611
US

IV. Provider business mailing address

404 E MINERAL AVE STE A
LITTLETON CO
80122-2611
US

V. Phone/Fax

Practice location:
  • Phone: 303-798-4400
  • Fax: 303-798-4700
Mailing address:
  • Phone: 303-798-4400
  • Fax: 303-798-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number130
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8176
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: