Provider Demographics
NPI:1194770180
Name:HURWITZ, MERVYN (DDS)
Entity type:Individual
Prefix:
First Name:MERVYN
Middle Name:
Last Name:HURWITZ
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 1:3015 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1771
Mailing Address - Country:US
Mailing Address - Phone:954-566-1548
Mailing Address - Fax:954-566-8055
Practice Address - Street 1:3015 BAYVIEW DR
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1771
Practice Address - Country:US
Practice Address - Phone:954-566-1548
Practice Address - Fax:954-566-8055
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL114651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice