MEDICARE: BRENT HURST DDSMSPC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	44486	CA

General Provider Information

NPI Number	:	1164512653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT HURST DDSMSPC

Provider Business Mailing Address
First Line	:	1207 CARLSBAD VILLAGE DR. #P
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008
Country	:	US
Telephone Number	:	760-729-8101
Fax Number	:	760-729-9696

Provider Business Practice Location Address
First Line	:	1207 CARLSBAD VILLAGE DR STE P
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1958
Country	:	US
Telephone Number	:	760-729-8101
Fax Number	:	760-729-9696

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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Directions to “ BRENT HURST DDSMSPC” Practice Location

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