Healthcare Provider Details

I. General information

NPI: 1285945154
Provider Name (Legal Business Name): BRENT MICHAEL HURST DMD, MBA, MS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1779 HIGHWAY 44 E STE 200
SHEPHERDSVILLE KY
40165-6132
US

IV. Provider business mailing address

11417 EXPEDITION TRL
LOUISVILLE KY
40291-5068
US

V. Phone/Fax

Practice location:
  • Phone: 502-281-4860
  • Fax: 502-281-4860
Mailing address:
  • Phone: 502-797-0762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8933
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8933
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: