Provider Demographics
NPI:1407906993
Name:HURT, AMESHA MONIQUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMESHA
Middle Name:MONIQUE
Last Name:HURT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:AMESHA
Other - Middle Name:MONIQUE
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2090 DUNWOODY CLUB DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-5406
Mailing Address - Country:US
Mailing Address - Phone:770-998-0111
Mailing Address - Fax:
Practice Address - Street 1:2090 DUNWOODY CLUB DR STE 105
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-5406
Practice Address - Country:US
Practice Address - Phone:770-831-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0139711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4791610Medicaid