Healthcare Provider Details

I. General information

NPI: 1124125919
Provider Name (Legal Business Name): ROBERT E HURST D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 EAST 135TH ST.
KANSAS CITY MO
64145
US

IV. Provider business mailing address

325 EAST 135TH ST
KANSAS CITY MO
64145
US

V. Phone/Fax

Practice location:
  • Phone: 816-941-7788
  • Fax: 816-941-4413
Mailing address:
  • Phone: 816-941-7788
  • Fax: 816-941-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberM015119
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number015119
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: