Provider Demographics
NPI:1376764209
Name:DURELL & DURELL DDS PC
Entity type:Organization
Organization Name:DURELL & DURELL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:DURELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-839-6106
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-0236
Mailing Address - Country:US
Mailing Address - Phone:317-839-6106
Mailing Address - Fax:
Practice Address - Street 1:1301 AGAN DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-7715
Practice Address - Country:US
Practice Address - Phone:317-839-6106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009474122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty