Provider Demographics
NPI:1770535148
Name:DURY, DOROTHY C (DDS)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:C
Last Name:DURY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4338 RANDOLPH TER
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1348
Mailing Address - Country:US
Mailing Address - Phone:619-294-9975
Mailing Address - Fax:
Practice Address - Street 1:NAVAL MEDICAL CENTER, SAN DIEGO
Practice Address - Street 2:34800 BOB WILSON DRIVE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-5000
Practice Address - Country:US
Practice Address - Phone:619-532-7398
Practice Address - Fax:619-532-5500
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7268122300000X
PADS023017L122300000X
CA50854122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist