Provider Demographics
NPI:1467585257
Name:DURISEK, THOMAS SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SCOTT
Last Name:DURISEK
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 1:6520 N 7TH AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1158
Mailing Address - Country:US
Mailing Address - Phone:602-246-9013
Mailing Address - Fax:602-249-7460
Practice Address - Street 1:6520 N 7TH AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1158
Practice Address - Country:US
Practice Address - Phone:602-246-9013
Practice Address - Fax:602-249-7460
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice