Provider Demographics
NPI:1508080235
Name:DOUGLAS D DURST DDS PC
Entity Type:Organization
Organization Name:DOUGLAS D DURST DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:DURST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-373-2119
Mailing Address - Street 1:51 GOODER SIMPSON BLVD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-9237
Mailing Address - Country:US
Mailing Address - Phone:405-373-2119
Mailing Address - Fax:405-373-0809
Practice Address - Street 1:51 GOODER SIMPSON BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73978-9237
Practice Address - Country:US
Practice Address - Phone:405-373-2119
Practice Address - Fax:405-373-0809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200092500AMedicaid