Provider Demographics
NPI:1407256233
Name:HURST CITY FAMILY AND COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:HURST CITY FAMILY AND COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:UMUNNA
Authorized Official - Last Name:NWOKORIE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:347-439-8901
Mailing Address - Street 1:2100 REEVES RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3855
Mailing Address - Country:US
Mailing Address - Phone:940-627-8400
Mailing Address - Fax:940-627-8402
Practice Address - Street 1:331 W HARWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3048
Practice Address - Country:US
Practice Address - Phone:817-369-3290
Practice Address - Fax:817-369-3292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25799122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215320712Medicaid