Provider Demographics
NPI:1033328349
Name:JURGENS & KNEEZEL LTD
Entity Type:Organization
Organization Name:JURGENS & KNEEZEL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:JURGENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:217-428-4685
Mailing Address - Street 1:334 W MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62522
Mailing Address - Country:US
Mailing Address - Phone:217-428-4683
Mailing Address - Fax:217-428-4738
Practice Address - Street 1:334 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62522
Practice Address - Country:US
Practice Address - Phone:217-428-4683
Practice Address - Fax:217-428-4738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty