Healthcare Provider Details

I. General information

NPI: 1487750212
Provider Name (Legal Business Name): HEATHER HURST D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 W RIDGE RD
FAIRVIEW PA
16415-1171
US

IV. Provider business mailing address

7435 W. RIDGE RD. PO BOX 50
FAIRVIEW PA
16415-0050
US

V. Phone/Fax

Practice location:
  • Phone: 814-474-2620
  • Fax: 814-474-3399
Mailing address:
  • Phone: 814-474-2620
  • Fax: 814-474-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS037267
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: