=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033477815
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOANNA L. HURD, DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2012
-----------------------------------------------------
Last Update Date | 04/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 D SE 3RD STREET SUITE 102
-----------------------------------------------------
City | LEE'S SUMMIT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-524-4509
-----------------------------------------------------
Fax | 816-524-4509
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 410 D SE 3RD STREET SUITE 102
-----------------------------------------------------
City | LEE'S SUMMIT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-524-4509
-----------------------------------------------------
Fax | 816-524-4509
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | DR. JOANNA LINN HURD
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 816-524-4509
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | MO2009012714
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------