Healthcare Provider Details

I. General information

NPI: 1871665232
Provider Name (Legal Business Name): DAVID JAMES HURT D.M.D, M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S VETERANS PKWY STE E
SPRINGFIELD IL
62704-6342
US

IV. Provider business mailing address

7941 TOLAN RD
PLEASANT PLAINS IL
62677-3956
US

V. Phone/Fax

Practice location:
  • Phone: 217-793-9001
  • Fax: 217-793-9188
Mailing address:
  • Phone: 217-626-1389
  • Fax: 217-793-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: