Provider Demographics
NPI:1568986511
Name:HURST FAMILY DENTAL CARE, PLLC
Entity Type:Organization
Organization Name:HURST FAMILY DENTAL CARE, PLLC
Other - Org Name:HURST FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:HAYS
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-474-1972
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72957-0819
Mailing Address - Country:US
Mailing Address - Phone:479-461-7811
Mailing Address - Fax:
Practice Address - Street 1:1205 E POINTER TRL
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-2317
Practice Address - Country:US
Practice Address - Phone:479-474-1972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR33241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148313608Medicaid