Provider Demographics
NPI:1801975636
Name:HURST, CHESTER LYNN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:LYNN
Last Name:HURST
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8171
Mailing Address - Street 2:
Mailing Address - City:HORSESHOE BAY
Mailing Address - State:TX
Mailing Address - Zip Code:78657-8171
Mailing Address - Country:US
Mailing Address - Phone:702-738-5334
Mailing Address - Fax:
Practice Address - Street 1:102 ESTRELLA
Practice Address - Street 2:
Practice Address - City:HORSESHOE BAY
Practice Address - State:TX
Practice Address - Zip Code:78657
Practice Address - Country:US
Practice Address - Phone:702-738-5334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140671223X0400X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507382Medicaid
TX1208795Medicaid