Provider Demographics
NPI:1467278515
Name:BRETT DURBIN, DDS, LLC
Entity type:Organization
Organization Name:BRETT DURBIN, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:T
Authorized Official - Last Name:DURBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-299-8666
Mailing Address - Street 1:2538 E WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-5244
Mailing Address - Country:US
Mailing Address - Phone:417-299-8666
Mailing Address - Fax:
Practice Address - Street 1:2235 E KEARNEY ST
Practice Address - Street 2:SPRINGFIELD, MO 65803
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-6580
Practice Address - Country:US
Practice Address - Phone:417-862-4192
Practice Address - Fax:417-862-5469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental