Provider Demographics
NPI:1346605219
Name:HURLEY FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:HURLEY FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-576-1777
Mailing Address - Street 1:14377 WOODLAKE DR STE 211
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5735
Mailing Address - Country:US
Mailing Address - Phone:314-576-1777
Mailing Address - Fax:
Practice Address - Street 1:14377 WOODLAKE DR STE 211
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5735
Practice Address - Country:US
Practice Address - Phone:314-576-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-20
Last Update Date:2015-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140155421223G0001X
MO20140155461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty