Provider Demographics
NPI:1467576355
Name:STEPHEN C. DURBIN, DDS, PC
Entity Type:Organization
Organization Name:STEPHEN C. DURBIN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DURBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-875-9031
Mailing Address - Street 1:400 W ENNIS AVE
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-3904
Mailing Address - Country:US
Mailing Address - Phone:972-875-9031
Mailing Address - Fax:972-878-9032
Practice Address - Street 1:400 W ENNIS AVE
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-3904
Practice Address - Country:US
Practice Address - Phone:972-875-9031
Practice Address - Fax:972-878-9032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13740122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty