Provider Demographics
NPI:1063527745
Name:WILLIAM C HURST, SR., D.M.D., P.C.
Entity type:Organization
Organization Name:WILLIAM C HURST, SR., D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-285-1218
Mailing Address - Street 1:6578 HURST LN
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-1173
Mailing Address - Country:US
Mailing Address - Phone:912-449-1389
Mailing Address - Fax:912-449-4502
Practice Address - Street 1:410 LISTER ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5226
Practice Address - Country:US
Practice Address - Phone:912-285-1218
Practice Address - Fax:912-285-9518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0131771223P0221X
GA0071911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000067251BMedicaid
GA197090698AMedicaid
GA197090698BMedicaid
GA000067251CMedicaid