Provider Demographics
NPI:1407903768
Name:HURLEY, J. PATRICK (DDS)
Entity Type:Individual
Prefix:
First Name:J.
Middle Name:PATRICK
Last Name:HURLEY
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 1:3775 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-5214
Mailing Address - Country:US
Mailing Address - Phone:707-546-3791
Mailing Address - Fax:707-546-9732
Practice Address - Street 1:3775 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-5214
Practice Address - Country:US
Practice Address - Phone:707-546-3791
Practice Address - Fax:707-546-9732
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist