Healthcare Provider Details

I. General information

NPI: 1740318096
Provider Name (Legal Business Name): ROBERT BRUCE HURLEY JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S GREENVILLE WEST DR SUITE 1
GREENVILLE MI
48838-3554
US

IV. Provider business mailing address

118 S GREENVILLE WEST DR SUITE 1
GREENVILLE MI
48838-3554
US

V. Phone/Fax

Practice location:
  • Phone: 616-754-9195
  • Fax: 616-754-7329
Mailing address:
  • Phone: 616-754-9195
  • Fax: 616-754-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10682
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: