Healthcare Provider Details

I. General information

NPI: 1457975948
Provider Name (Legal Business Name): HURST AND SHANNON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PINE ST STE 2017
SEATTLE WA
98101-3625
US

IV. Provider business mailing address

400 PINE ST STE 2017
SEATTLE WA
98101-3625
US

V. Phone/Fax

Practice location:
  • Phone: 844-295-6915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CHESTER LYNN HURST
Title or Position: PRESIDENT
Credential: DDS
Phone: 844-295-6915