MEDICARE: DR. GREGORY A. HURT M.S, D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	32097	CA

General Provider Information

NPI Number	:	1023109329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY A. HURT M.S, D.D.S.

Provider Business Mailing Address
First Line	:	162 S RANCHO SANTA FE RD
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-2502
Country	:	US
Telephone Number	:	760-734-4311
Fax Number	:	760-599-1107

Provider Business Practice Location Address
First Line	:	162 S RANCHO SANTA FE RD
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-2502
Country	:	US
Telephone Number	:	760-734-4311
Fax Number	:	760-599-1107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	06/13/2015

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