Provider Demographics
NPI:1649557323
Name:G&D DURAN LLC
Entity Type:Organization
Organization Name:G&D DURAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BELKIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-623-7018
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-0339
Mailing Address - Country:US
Mailing Address - Phone:914-623-7018
Mailing Address - Fax:914-207-0591
Practice Address - Street 1:510 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-3253
Practice Address - Country:US
Practice Address - Phone:914-623-7018
Practice Address - Fax:914-207-0591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053352-11223G0001X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02838026Medicaid