Healthcare Provider Details

I. General information

NPI: 1265632871
Provider Name (Legal Business Name): MARK D HURD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2007
Last Update Date: 07/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 OUTLOOK BLVD STE C
PUEBLO CO
81008-1696
US

IV. Provider business mailing address

3901 OUTLOOK BLVD STE C
PUEBLO CO
81008-1696
US

V. Phone/Fax

Practice location:
  • Phone: 719-544-7020
  • Fax:
Mailing address:
  • Phone: 719-544-7020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6486
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: