Healthcare Provider Details

I. General information

NPI: 1003194168
Provider Name (Legal Business Name): ADAM R HURST DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2011
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 W GORDON AVE STE G
LAYTON UT
84041-6508
US

IV. Provider business mailing address

3225 W GORDON AVE STE G
LAYTON UT
84041-6508
US

V. Phone/Fax

Practice location:
  • Phone: 801-544-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8031888-8903
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: