Healthcare Provider Details

I. General information

NPI: 1235575176
Provider Name (Legal Business Name): EUN LAUREN HUR DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 SUMMIT AVE
JERSEY CITY NJ
07306-3101
US

IV. Provider business mailing address

412 SUMMIT AVE
JERSEY CITY NJ
07306-3101
US

V. Phone/Fax

Practice location:
  • Phone: 201-499-1975
  • Fax: 201-946-6804
Mailing address:
  • Phone: 201-499-1975
  • Fax: 201-946-6804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI0252534300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: