Provider Demographics
NPI:1679661623
Name:HURT, KENNETH C (DDS, MS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:HURT
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:6330 RIVERSIDE PLAZA LN NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2681
Mailing Address - Country:US
Mailing Address - Phone:505-897-2060
Mailing Address - Fax:505-890-4256
Practice Address - Street 1:6330 RIVERSIDE PLAZA LN NW
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2681
Practice Address - Country:US
Practice Address - Phone:505-897-2060
Practice Address - Fax:505-890-4256
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMDD18141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics