Provider Demographics
NPI:1174511182
Name:HURME, RISTO EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:RISTO
Middle Name:EDWARD
Last Name:HURME
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 1:105 E MULBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2947
Mailing Address - Country:US
Mailing Address - Phone:210-734-9451
Mailing Address - Fax:
Practice Address - Street 1:1017 SHOOK AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2508
Practice Address - Country:US
Practice Address - Phone:210-826-4441
Practice Address - Fax:210-826-0609
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX126641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD12664Medicare ID - Type Unspecified
TXU15166Medicare UPIN