Provider Demographics
NPI:1588022974
Name:FURRY, JUANITA (RDH)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:FURRY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 BRUNSWICK ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-1210
Mailing Address - Country:US
Mailing Address - Phone:563-580-9120
Mailing Address - Fax:
Practice Address - Street 1:1789 ELM ST
Practice Address - Street 2:SUITE A
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-2256
Practice Address - Country:US
Practice Address - Phone:563-690-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1785124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist