Provider Demographics
NPI:1508036476
Name:HURD, EDWIN M JR (DDS)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:M
Last Name:HURD
Suffix:JR
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 1:13075 OLD FREDERICK ROAD
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-5612
Mailing Address - Country:US
Mailing Address - Phone:410-442-2239
Mailing Address - Fax:410-442-2239
Practice Address - Street 1:13075 OLD FREDERICK ROAD
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-5612
Practice Address - Country:US
Practice Address - Phone:410-442-2239
Practice Address - Fax:410-442-2239
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD070971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice