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Individual
DR. RUSSELL CHARLES HURST JR.
Active
Individual
DR. RUSSELL CHARLES HURST JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2501
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2501
STATE LICENSE
SC
Enumeration date
04/16/2007
Last updated
04/20/2020
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