Healthcare Provider Details

I. General information

NPI: 1780848929
Provider Name (Legal Business Name): DEBRA SUE HURTT D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 S HIGH ST
COLUMBUS OH
43206-3411
US

IV. Provider business mailing address

1128 S HIGH ST
COLUMBUS OH
43206-3411
US

V. Phone/Fax

Practice location:
  • Phone: 614-444-6171
  • Fax:
Mailing address:
  • Phone: 614-444-6171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19678
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: