MEDICARE: DR. DEBRA SUE HURTT 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	19678	OH

General Provider Information

NPI Number	:	1780848929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBRA SUE HURTT D.D.S.

Provider Business Mailing Address
First Line	:	1128 S HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-3411
Country	:	US
Telephone Number	:	614-444-6171
Fax Number	:

Provider Business Practice Location Address
First Line	:	1128 S HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-3411
Country	:	US
Telephone Number	:	614-444-6171
Fax Number	:

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

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	07/16/2008

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