Healthcare Provider Details

I. General information

NPI: 1033231519
Provider Name (Legal Business Name): ERIC MICHAEL HURST SR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

216 I45 SOUTH
LEAGUE CITY TX
77573
US

IV. Provider business mailing address

216 I45 SOUTH
LEAGUE CITY TX
77573
US

V. Phone/Fax

Practice location:
  • Phone: 281-338-6559
  • Fax: 281-338-4953
Mailing address:
  • Phone: 281-338-6559
  • Fax: 281-338-4953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15918
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: