Provider Demographics
NPI:1285854505
Name:HUR, CHARLES C (DMD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:C
Last Name:HUR
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 1:57 BEDFORD STREET
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420
Mailing Address - Country:US
Mailing Address - Phone:781-861-6401
Mailing Address - Fax:781-861-6258
Practice Address - Street 1:57 BEDFORD STREET
Practice Address - Street 2:SUITE 205 ICON DPMG LLC DBA ICON DENTAL
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420
Practice Address - Country:US
Practice Address - Phone:781-861-6401
Practice Address - Fax:781-861-6258
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA177771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice