Healthcare Provider Details

I. General information

NPI: 1902900178
Provider Name (Legal Business Name): MICHAEL TERRY HURT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4270 PLAINFIELD NE
GRAND RAPIDS MI
49525-1603
US

IV. Provider business mailing address

4270 PLAINFIELD NE
GRAND RAPIDS MI
49525-1603
US

V. Phone/Fax

Practice location:
  • Phone: 616-361-9497
  • Fax:
Mailing address:
  • Phone: 616-361-9497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901008480
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: