Provider Demographics
NPI:1326020017
Name:HURLEY, ROBERT W (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
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 1:1026 WOODBURY AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-7915
Mailing Address - Country:US
Mailing Address - Phone:712-328-8573
Mailing Address - Fax:
Practice Address - Street 1:3004 N 13TH ST
Practice Address - Street 2:
Practice Address - City:CARTER LAKE
Practice Address - State:IA
Practice Address - Zip Code:51510-1438
Practice Address - Country:US
Practice Address - Phone:712-347-6151
Practice Address - Fax:712-847-0164
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA68551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA20363OtherBLUE CROSS BLUE SHIELD
IA2203638Medicaid
NE07881OtherBLUE CROSS BLUE SHIELD
628884OtherUNITED CONCORDIA