Healthcare Provider Details

I. General information

NPI: 1801941133
Provider Name (Legal Business Name): HURST FAMILY DENTISTRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 MAIN ST. SUITE B
HULL IA
51239-7336
US

IV. Provider business mailing address

807 MAIN ST. SUITE B
HULL IA
51239-7336
US

V. Phone/Fax

Practice location:
  • Phone: 712-439-2666
  • Fax: 712-439-2599
Mailing address:
  • Phone: 712-439-2666
  • Fax: 712-439-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number08204
License Number StateIA

VIII. Authorized Official

Name: DR. JUSTIN GLEN HURST
Title or Position: PRESIDENT
Credential: DDS
Phone: 712-439-2666