Organization
WILLIAM C HURST, SR., D.M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAM C HURST (BUSINESS MANAGER)
(912) 285-1218
Entity
Organization
Contact information
Practice address
410 LISTER ST, WAYCROSS, GA 31501-5226
(912) 285-1218
(912) 285-9518
Mailing address
6578 HURST LN, BLACKSHEAR, GA 31516-1173
(912) 449-1389
(912) 449-4502
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
007191
GA
1223P0221X
Pediatric Dentistry
013177
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000067251B
—
GA
05
—
000067251C
—
GA
05
—
197090698A
—
GA
05
—
197090698B
—
GA
Enumeration date
08/20/2006
Last updated
09/26/2013
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