Provider Demographics
NPI:1679949853
Name:MARK D. HURD, D.D.S.
Entity Type:Organization
Organization Name:MARK D. HURD, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:HURD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-544-7020
Mailing Address - Street 1:3901 OUTLOOK BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1698
Mailing Address - Country:US
Mailing Address - Phone:719-544-7020
Mailing Address - Fax:719-544-5982
Practice Address - Street 1:3901 OUTLOOK BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1698
Practice Address - Country:US
Practice Address - Phone:719-544-7020
Practice Address - Fax:719-544-5982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6486122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6486OtherSTATE DENTAL LICENSE