Healthcare Provider Details

I. General information

NPI: 1700382645
Provider Name (Legal Business Name): DAEUN HUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2018
Last Update Date: 07/29/2022
Certification Date: 03/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 MAIN ST
MILFORD MA
01757-2627
US

IV. Provider business mailing address

189 MAIN ST
MILFORD MA
01757-2627
US

V. Phone/Fax

Practice location:
  • Phone: 508-473-4220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN1859313
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: