Healthcare Provider Details

I. General information

NPI: 1457430894
Provider Name (Legal Business Name): HENRY CARL HURWITZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 WALNUT ST SUITE 1000
PHILADELPHIA PA
19103-5313
US

IV. Provider business mailing address

1616 WALNUT ST SUITE 1000
PHILADELPHIA PA
19103-5313
US

V. Phone/Fax

Practice location:
  • Phone: 215-732-9171
  • Fax: 215-732-9376
Mailing address:
  • Phone: 215-732-9171
  • Fax: 215-732-9376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS017291L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: