Provider Demographics
NPI:1851581979
Name:HURST, LORI DEBRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:DEBRA
Last Name:HURST
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 FOURTH STREET
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905
Mailing Address - Country:US
Mailing Address - Phone:203-324-3121
Mailing Address - Fax:203-348-0969
Practice Address - Street 1:61 FOURTH STREET
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905
Practice Address - Country:US
Practice Address - Phone:203-324-3121
Practice Address - Fax:203-348-0969
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007758122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist