Provider Demographics
NPI:1063534857
Name:HURD, AUTUMN G (DDS)
Entity type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:G
Last Name:HURD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E MINERAL AVE
Mailing Address - Street 2:STE A
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2611
Mailing Address - Country:US
Mailing Address - Phone:303-798-4400
Mailing Address - Fax:303-798-4700
Practice Address - Street 1:404 E MINERAL AVE
Practice Address - Street 2:STE A
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2611
Practice Address - Country:US
Practice Address - Phone:303-798-4400
Practice Address - Fax:303-798-4700
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1301223P0221X
CO81761223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08184275Medicaid