Provider Demographics
NPI:1073160644
Name:HURTIG, ALDEN STANTON
Entity Type:Individual
Prefix:DR
First Name:ALDEN
Middle Name:STANTON
Last Name:HURTIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6625
Mailing Address - Country:US
Mailing Address - Phone:207-872-6815
Mailing Address - Fax:207-872-6888
Practice Address - Street 1:185 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6625
Practice Address - Country:US
Practice Address - Phone:207-872-6815
Practice Address - Fax:207-872-6888
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN47181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice