Healthcare Provider Details

I. General information

NPI: 1568536258
Provider Name (Legal Business Name): BERNARD R HURLBUT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 RICK FRANCIS ST
EL PASO TX
79905-2817
US

IV. Provider business mailing address

1001 SHADOW LANE A103
LAS VEGAS NV
89106
US

V. Phone/Fax

Practice location:
  • Phone: 915-215-6700
  • Fax:
Mailing address:
  • Phone: 702-774-2816
  • Fax: 702-774-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4787T
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number39188
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: