Provider Demographics
NPI:1245343201
Name:DURBIN, DAWN R (DDS, PC)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:DURBIN
Suffix:
Gender:F
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-1925
Mailing Address - Country:US
Mailing Address - Phone:812-738-2166
Mailing Address - Fax:812-738-2167
Practice Address - Street 1:1161 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-1925
Practice Address - Country:US
Practice Address - Phone:812-738-2166
Practice Address - Fax:812-738-2167
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120100011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice