Provider Demographics
NPI:1558720128
Name:HURTADO, ANDRES MAURICIO (DDS)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:MAURICIO
Last Name:HURTADO
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 1:8505 E ALAMEDA AVE
Mailing Address - Street 2:UNIT # 3112
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-5033
Mailing Address - Country:US
Mailing Address - Phone:302-588-3280
Mailing Address - Fax:
Practice Address - Street 1:1802 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3420
Practice Address - Country:US
Practice Address - Phone:302-652-2455
Practice Address - Fax:302-322-6251
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO202743122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist