Healthcare Provider Details

I. General information

NPI: 1801051495
Provider Name (Legal Business Name): JUSTIN EDWIN HURLBURT D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 STATE ST
SCHENECTADY NY
12307-1508
US

IV. Provider business mailing address

1044 STATE ST
SCHENECTADY NY
12307-1508
US

V. Phone/Fax

Practice location:
  • Phone: 518-370-1441
  • Fax: 518-395-9431
Mailing address:
  • Phone: 518-370-1441
  • Fax: 518-395-9431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number016.0133835
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number053921
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: