Provider Demographics
NPI:1417060674
Name:DURR, MICHAEL ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:DURR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5006
Mailing Address - Country:US
Mailing Address - Phone:618-529-2471
Mailing Address - Fax:618-529-2482
Practice Address - Street 1:1111 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5006
Practice Address - Country:US
Practice Address - Phone:618-529-2471
Practice Address - Fax:618-529-2482
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0157651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice