Provider Demographics
NPI:1396310975
Name:HURT, FARAMOLU OWOKOTOMO (DDS)
Entity type:Individual
Prefix:DR
First Name:FARAMOLU
Middle Name:OWOKOTOMO
Last Name:HURT
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 1:1375 HOLLY AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3294
Mailing Address - Country:US
Mailing Address - Phone:419-979-2071
Mailing Address - Fax:
Practice Address - Street 1:2765 FORT AMANDA RD STE 200
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-4813
Practice Address - Country:US
Practice Address - Phone:419-979-2071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0264521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice