Healthcare Provider Details

I. General information

NPI: 1538451091
Provider Name (Legal Business Name): DAVID HURLBUT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 ARSENAL STREET
WATERTOWN NY
13601
US

IV. Provider business mailing address

1116 ARSENAL STREET
WATERTOWN NY
13601
US

V. Phone/Fax

Practice location:
  • Phone: 315-779-2222
  • Fax:
Mailing address:
  • Phone: 315-779-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number056358
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: