Provider Demographics
NPI:1023236247
Name:HURST, JAMES OTIS (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:OTIS
Last Name:HURST
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 1:9000 N. MAIN STREET
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415
Mailing Address - Country:US
Mailing Address - Phone:937-836-7282
Mailing Address - Fax:937-836-7394
Practice Address - Street 1:9000 N. MAIN STREET
Practice Address - Street 2:SUITE 207
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415
Practice Address - Country:US
Practice Address - Phone:937-836-7282
Practice Address - Fax:937-836-7394
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH162581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice