Provider Demographics
NPI:1144359092
Name:HURLEY, RANDY STEVEN (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:STEVEN
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 1:1151 W IRON SPRINGS RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1614
Mailing Address - Country:US
Mailing Address - Phone:928-771-2526
Mailing Address - Fax:928-777-2469
Practice Address - Street 1:1151 W IRON SPRINGS RD
Practice Address - Street 2:SUITE F
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1614
Practice Address - Country:US
Practice Address - Phone:928-771-2526
Practice Address - Fax:928-777-2469
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4339OtherSTATE DENTAL LICENSE