Provider Demographics
NPI:1841421682
Name:NICHOLAS J. HURLEYD D.D.S,, P.A.
Entity Type:Organization
Organization Name:NICHOLAS J. HURLEYD D.D.S,, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-476-1109
Mailing Address - Street 1:1040 RANDOLPH ST
Mailing Address - Street 2:SUITE 19
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-6383
Mailing Address - Country:US
Mailing Address - Phone:336-476-1109
Mailing Address - Fax:336-476-1101
Practice Address - Street 1:1040 RANDOLPH ST
Practice Address - Street 2:SUITE 19
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-6383
Practice Address - Country:US
Practice Address - Phone:336-476-1109
Practice Address - Fax:336-476-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC84331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty