Provider Demographics
NPI:1902023104
Name:HURD, MICHAEL A (DDS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:HURD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 GARTH RD. #180
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521
Mailing Address - Country:US
Mailing Address - Phone:281-427-1516
Mailing Address - Fax:281-427-2162
Practice Address - Street 1:4002 GARTH RD. #180
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521
Practice Address - Country:US
Practice Address - Phone:281-427-1516
Practice Address - Fax:281-427-2162
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17881122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-5064589OtherTAX ID #
TX562395552OtherTAX ID #