Provider Demographics
NPI:1871511816
Name:DURDEN, DUSTIN RYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:RYAN
Last Name:DURDEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1325
Mailing Address - Country:US
Mailing Address - Phone:919-832-8931
Mailing Address - Fax:
Practice Address - Street 1:2945 NEW BERN AVE.
Practice Address - Street 2:WIRCK & ASSOCIATES
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610
Practice Address - Country:US
Practice Address - Phone:919-834-4932
Practice Address - Fax:919-834-7332
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902KAMedicaid