Healthcare Provider Details

I. General information

NPI: 1710047667
Provider Name (Legal Business Name): PETER HURST BDS, MS, MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E HURON ST GALTER PAVILION, 2-246
CHICAGO IL
60611-3197
US

IV. Provider business mailing address

201 E HURON ST GALTER PAVILION, 2-246
CHICAGO IL
60611-3197
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-3264
  • Fax: 312-926-3885
Mailing address:
  • Phone: 312-926-3264
  • Fax: 312-926-3885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: