Provider Demographics
NPI:1477522266
Name:HURST, RICK LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:LEE
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 1:508 RUSSELL BLVD
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1244
Mailing Address - Country:US
Mailing Address - Phone:936-569-1111
Mailing Address - Fax:
Practice Address - Street 1:508 RUSSELL BLVD
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1244
Practice Address - Country:US
Practice Address - Phone:936-569-1111
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT13978Medicare UPIN
TX8186J0Medicare ID - Type Unspecified