Healthcare Provider Details

I. General information

NPI: 1588654206
Provider Name (Legal Business Name): JEFFREY D HURST DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W WASHINGTON AVE SUITE 201
JACKSON MI
49201-2169
US

IV. Provider business mailing address

1547 RIDGE RD
CHELSEA MI
48118-9793
US

V. Phone/Fax

Practice location:
  • Phone: 517-784-3009
  • Fax: 517-784-4544
Mailing address:
  • Phone: 734-475-2180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number012806
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: