Provider Demographics
NPI:1750838207
Name:DURAN, ILIANA
Entity Type:Individual
Prefix:MRS
First Name:ILIANA
Middle Name:
Last Name:DURAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5372 JOSE DURAN LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3184
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11334 SSG SIMS RD
Practice Address - Street 2:
Practice Address - City:FT. BLISS
Practice Address - State:TX
Practice Address - Zip Code:79908
Practice Address - Country:US
Practice Address - Phone:915-742-6083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant