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General NPI Number Information
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NPI Number | 1134614514
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Entity Type | Individual
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Provider Name | KOREY TAYLOR HURLEY DMD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 6030 PARK BLVD N
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City | PINELLAS PARK
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State | FL
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Zip | 33781-3228
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Country | US
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Telephone | 727-547-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 151 7TH ST S UNIT 702
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4082
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Country | US
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Telephone | 727-542-1500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN23537
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License Number State | FL
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