Provider Demographics
NPI:1235239237
Name:HURLEY, JOSEPH CLINTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CLINTON
Last Name:HURLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:J
Other - Middle Name:CLINT
Other - Last Name:HURLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:
Mailing Address - City:WHITE PINE
Mailing Address - State:TN
Mailing Address - Zip Code:37890
Mailing Address - Country:US
Mailing Address - Phone:865-674-2541
Mailing Address - Fax:865-674-6484
Practice Address - Street 1:3231 ROY MESSER HWY
Practice Address - Street 2:
Practice Address - City:WHITE PINE
Practice Address - State:TN
Practice Address - Zip Code:37890
Practice Address - Country:US
Practice Address - Phone:865-674-2541
Practice Address - Fax:865-674-6484
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0052791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3225792Medicaid
TNDS005279OtherLICENSE
U71076Medicare UPIN