Healthcare Provider Details

I. General information

NPI: 1720752058
Provider Name (Legal Business Name): ALLISON CHRISTINE HURLBUT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5611 NW 1ST ST STE 108
LINCOLN NE
68521-4466
US

IV. Provider business mailing address

17455 PRAIRIE VISTA DR
ROCA NE
68430
US

V. Phone/Fax

Practice location:
  • Phone: 402-438-5588
  • Fax: 402-438-5715
Mailing address:
  • Phone: 402-499-5279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7729
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: