Provider Demographics
NPI:1225128598
Name:DURAN, TOMAS LEONIDES (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:LEONIDES
Last Name:DURAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4846 SEASONS VW
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1952
Mailing Address - Country:US
Mailing Address - Phone:719-544-3610
Mailing Address - Fax:
Practice Address - Street 1:830 W ABRIENDO AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1500
Practice Address - Country:US
Practice Address - Phone:719-545-3838
Practice Address - Fax:719-545-0025
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1041671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice