Provider Demographics
NPI:1497366819
Name:DURSCHLAG DENTAL CORP
Entity Type:Organization
Organization Name:DURSCHLAG DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DURSCHLAG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-248-7005
Mailing Address - Street 1:11921 CARMEL CREEK RD APT 109
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2566
Mailing Address - Country:US
Mailing Address - Phone:858-248-7005
Mailing Address - Fax:
Practice Address - Street 1:239 LAUREL ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1473
Practice Address - Country:US
Practice Address - Phone:619-291-5266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty