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General NPI Number Information
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NPI Number | 1336583525
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Entity Type | Organization
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Legal Business Name | HURLEY FAMILY DENTAL CARE
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Dates
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Enumeration Date | 04/18/2013
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Last Update Date | 04/18/2013
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Provider Practice Location Address
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Address Line | 7305 HIGHWAY 614
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City | MOSS POINT
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State | MS
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Zip | 39562-6369
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Country | US
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Telephone | 228-588-6027
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Fax | 228-588-0255
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Provider Business Mailing Address
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Address Line | 7305 HWY 614
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City | HURLEY
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State | MS
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Zip | 39555
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Country | US
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Telephone | 228-588-6027
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Fax | 228-588-0255
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Authorized Official
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Title or Position | OWNER
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Name | DR. HUBERT H PARKER IV
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Credential | DMD
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Telephone | 228-588-6027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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