Provider Demographics
NPI:1114124005
Name:HURLEY, NICHOLAS JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JOHN
Last Name:HURLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 RANDOLPH ST
Mailing Address - Street 2:SUITE19
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-6383
Mailing Address - Country:US
Mailing Address - Phone:336-476-1109
Mailing Address - Fax:336-476-1101
Practice Address - Street 1:1020 RANDOLPH ST
Practice Address - Street 2:SUITE 19
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-5877
Practice Address - Country:US
Practice Address - Phone:336-476-1109
Practice Address - Fax:336-476-1101
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC84331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice