Provider Demographics
NPI:1225150782
Name:HURST, JOBY LEE (DMD)
Entity Type:Individual
Prefix:
First Name:JOBY
Middle Name:LEE
Last Name:HURST
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2894 ACTON RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2502
Mailing Address - Country:US
Mailing Address - Phone:205-969-7454
Mailing Address - Fax:205-969-7458
Practice Address - Street 1:2894 ACTON RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2502
Practice Address - Country:US
Practice Address - Phone:205-969-7454
Practice Address - Fax:205-969-7458
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00031552Medicaid
AL51031552OtherBLUECROSS AND BLUE SHIELD
AL51031552OtherBLUECROSS AND BLUE SHIELD