Healthcare Provider Details

I. General information

NPI: 1336202340
Provider Name (Legal Business Name): IRENE RITA HURST D.M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 CROSSWINDS DR N SUITE 300B
ST PETERSBURG FL
33710-8602
US

IV. Provider business mailing address

6700 CROSSWINDS DR N SUITE 300B
ST PETERSBURG FL
33710-8602
US

V. Phone/Fax

Practice location:
  • Phone: 727-384-4511
  • Fax: 727-341-0610
Mailing address:
  • Phone: 727-384-4511
  • Fax: 727-341-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN15677
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: