Provider Demographics
NPI:1710047667
Name:HURST, PETER (BDS, MS, MSC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:HURST
Suffix:
Gender:M
Credentials:BDS, MS, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E HURON ST
Mailing Address - Street 2:GALTER PAVILION, 2-246
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3197
Mailing Address - Country:US
Mailing Address - Phone:312-926-3264
Mailing Address - Fax:312-926-3885
Practice Address - Street 1:201 E HURON ST
Practice Address - Street 2:GALTER PAVILION, 2-246
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3197
Practice Address - Country:US
Practice Address - Phone:312-926-3264
Practice Address - Fax:312-926-3885
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice