Healthcare Provider Details

I. General information

NPI: 1336583525
Provider Name (Legal Business Name): HURLEY FAMILY DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 HIGHWAY 614
MOSS POINT MS
39562-6369
US

IV. Provider business mailing address

7305 HWY 614
HURLEY MS
39555
US

V. Phone/Fax

Practice location:
  • Phone: 228-588-6027
  • Fax: 228-588-0255
Mailing address:
  • Phone: 228-588-6027
  • Fax: 228-588-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. HUBERT H PARKER IV
Title or Position: OWNER
Credential: DMD
Phone: 228-588-6027