Provider Demographics
NPI:1871665232
Name:HURT, DAVID JAMES (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAMES
Last Name:HURT
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7941 TOLAN RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PLAINS
Mailing Address - State:IL
Mailing Address - Zip Code:62677-3956
Mailing Address - Country:US
Mailing Address - Phone:217-626-1389
Mailing Address - Fax:217-793-9188
Practice Address - Street 1:1201 S VETERANS PKWY STE E
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6342
Practice Address - Country:US
Practice Address - Phone:217-793-9001
Practice Address - Fax:217-793-9188
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics