Provider Demographics
NPI:1528233384
Name:PHILLIP H. DURDEN, DMD, PC
Entity Type:Organization
Organization Name:PHILLIP H. DURDEN, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:H
Authorized Official - Last Name:DURDEN
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-742-7000
Mailing Address - Street 1:104 MOORES GROVE RD
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30683-1506
Mailing Address - Country:US
Mailing Address - Phone:706-742-7000
Mailing Address - Fax:706-742-2145
Practice Address - Street 1:104 MOORES GROVE RD
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30683-1506
Practice Address - Country:US
Practice Address - Phone:706-742-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINTERVILLE DENTAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-23
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN010773261QD0000X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental