Provider Demographics
NPI:1508416967
Name:ERIC HURTTE D.M.D, P.C.
Entity Type:Organization
Organization Name:ERIC HURTTE D.M.D, P.C.
Other - Org Name:BOARDWALK FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FRONT DESK
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKEMPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-561-4117
Mailing Address - Street 1:749 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:EOLIA
Mailing Address - State:MO
Mailing Address - Zip Code:63344-2321
Mailing Address - Country:US
Mailing Address - Phone:636-734-7879
Mailing Address - Fax:
Practice Address - Street 1:7766 WINGHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3601
Practice Address - Country:US
Practice Address - Phone:636-561-4117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization