Provider Demographics
NPI:1891822490
Name:PAUL R. DURYEA DDS MS PA
Entity Type:Organization
Organization Name:PAUL R. DURYEA DDS MS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:DURYEA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:727-785-8847
Mailing Address - Street 1:2595 TAMPA RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3152
Mailing Address - Country:US
Mailing Address - Phone:727-785-8847
Mailing Address - Fax:727-785-9372
Practice Address - Street 1:2595 TAMPA RD
Practice Address - Street 2:SUITE I
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3152
Practice Address - Country:US
Practice Address - Phone:727-785-8847
Practice Address - Fax:727-785-9372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00085021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty