Healthcare Provider Details

I. General information

NPI: 1619099603
Provider Name (Legal Business Name): BRIAN P HURT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 MIDDLETOWN RD
COLCHESTER CT
06415-2236
US

IV. Provider business mailing address

5 OLD COUNTRY RD
COLCHESTER CT
06415-2211
US

V. Phone/Fax

Practice location:
  • Phone: 860-267-8889
  • Fax:
Mailing address:
  • Phone: 860-267-7962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberCT4863
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: