Provider Demographics
NPI:1346334109
Name:HURST, EDWIN SCHAUB (DDS)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:SCHAUB
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 1:150 E 200 N STE B1
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4036
Mailing Address - Country:US
Mailing Address - Phone:435-752-4533
Mailing Address - Fax:435-752-4586
Practice Address - Street 1:150 E 200 N STE B1
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4036
Practice Address - Country:US
Practice Address - Phone:435-752-4533
Practice Address - Fax:435-752-4586
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1421351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice