Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS-02590-L | PA |
NPI | 1114236197 |
---|---|
Provider Name | Craig Hurtt |
First Address | Villanova, PA 19085-1400 |
Second Address | Villanova, PA 19085-1400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2010 |
Last Update Date | 24/09/2010 |