Provider Demographics
NPI:1033477815
Name:JOANNA L. HURD, DDS, PC
Entity Type:Organization
Organization Name:JOANNA L. HURD, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:LINN
Authorized Official - Last Name:HURD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-524-4509
Mailing Address - Street 1:410 D SE 3RD STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEE'S SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063
Mailing Address - Country:US
Mailing Address - Phone:816-524-4509
Mailing Address - Fax:816-524-4509
Practice Address - Street 1:410 D SE 3RD STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:LEE'S SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063
Practice Address - Country:US
Practice Address - Phone:816-524-4509
Practice Address - Fax:816-524-4509
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOANNA L. HURD, DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO2009012714122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty