Provider Demographics
NPI:1134399512
Name:JASON C HURLEY DDS
Entity type:Organization
Organization Name:JASON C HURLEY DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-435-6002
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76665-0218
Mailing Address - Country:US
Mailing Address - Phone:254-435-6002
Mailing Address - Fax:254-435-2900
Practice Address - Street 1:101 W. RIVER ST.
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:TX
Practice Address - Zip Code:76665
Practice Address - Country:US
Practice Address - Phone:254-435-6002
Practice Address - Fax:254-435-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty