Healthcare Provider Details

I. General information

NPI: 1073400354
Provider Name (Legal Business Name): EUN A HUR DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4799 ATLANTA HWY STE 500
LOGANVILLE GA
30052-7467
US

IV. Provider business mailing address

91 MARKET ST APT 1216
BETHLEHEM GA
30620-1896
US

V. Phone/Fax

Practice location:
  • Phone: 404-720-6097
  • Fax:
Mailing address:
  • Phone: 954-410-6878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN30498
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN123896
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: