Provider Demographics
NPI:1255307310
Name:HURST, JEFFERY MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:MARK
Last Name:HURST
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 1:1927 DENVER WEST CT
Mailing Address - Street 2:APT 1934
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-0948
Mailing Address - Country:US
Mailing Address - Phone:303-277-9975
Mailing Address - Fax:303-238-0343
Practice Address - Street 1:2315 KIPLING ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-1584
Practice Address - Country:US
Practice Address - Phone:303-238-5812
Practice Address - Fax:303-238-0343
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1048841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice