Provider Demographics
NPI:1851493977
Name:DURDEN, PHILLIP HUE IV (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:HUE
Last Name:DURDEN
Suffix:IV
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:706-742-2145
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0107731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice