MEDICARE: DR. ROBERT W HURLEY 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	6855	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20363	OTHER	IA	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	07881	OTHER	NE	BLUE CROSS BLUE SHIELD
4	628884	OTHER		UNITED CONCORDIA

General Provider Information

NPI Number	:	1326020017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT W HURLEY D.D.S.

Provider Business Mailing Address
First Line	:	1026 WOODBURY AVE
Second Line	:
City	:	COUNCIL BLUFFS
State	:	IA
Zip	:	51503-7915
Country	:	US
Telephone Number	:	712-328-8573
Fax Number	:

Provider Business Practice Location Address
First Line	:	3004 N 13TH ST
Second Line	:
City	:	CARTER LAKE
State	:	IA
Zip	:	51510-1438
Country	:	US
Telephone Number	:	712-347-6151
Fax Number	:	712-847-0164

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	09/20/2011

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