Provider Demographics
NPI:1255736278
Name:HURLEY, CHARLES DANIEL (DDS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:DANIEL
Last Name:HURLEY
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 1:14377 WOODLAKE DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5735
Mailing Address - Country:US
Mailing Address - Phone:314-576-1777
Mailing Address - Fax:314-576-4584
Practice Address - Street 1:14377 WOODLAKE DR
Practice Address - Street 2:STE 211
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5735
Practice Address - Country:US
Practice Address - Phone:314-576-1777
Practice Address - Fax:314-576-4584
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014015546122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist