Healthcare Provider Details

I. General information

NPI: 1023236247
Provider Name (Legal Business Name): JAMES OTIS HURST D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 N. MAIN STREET SUITE 207
DAYTON OH
45415
US

IV. Provider business mailing address

9000 N. MAIN STREET SUITE 207
DAYTON OH
45415
US

V. Phone/Fax

Practice location:
  • Phone: 937-836-7282
  • Fax: 937-836-7394
Mailing address:
  • Phone: 937-836-7282
  • Fax: 937-836-7394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16258
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: