Healthcare Provider Details

I. General information

NPI: 1588024517
Provider Name (Legal Business Name): PHILIP JONES HURST DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 W IOWA AVE
NAMPA ID
83686-2856
US

IV. Provider business mailing address

3024 E FRATELLO ST
MERIDIAN ID
83642-9336
US

V. Phone/Fax

Practice location:
  • Phone: 208-467-1227
  • Fax:
Mailing address:
  • Phone: 214-405-0301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD-5376-OS
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: