Healthcare Provider Details

I. General information

NPI: 1174511182
Provider Name (Legal Business Name): RISTO EDWARD HURME D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 SHOOK AVE
SAN ANTONIO TX
78212-2508
US

IV. Provider business mailing address

105 E MULBERRY AVE
SAN ANTONIO TX
78212-2947
US

V. Phone/Fax

Practice location:
  • Phone: 210-826-4441
  • Fax: 210-826-0609
Mailing address:
  • Phone: 210-734-9451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12664
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: