Provider Demographics
NPI:1831252162
Name:ANTHONY W DURALL DMD PSC
Entity type:Organization
Organization Name:ANTHONY W DURALL DMD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:W
Authorized Official - Last Name:DURALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMDD
Authorized Official - Phone:270-683-0275
Mailing Address - Street 1:2816 VEACH RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303
Mailing Address - Country:US
Mailing Address - Phone:270-683-0275
Mailing Address - Fax:270-683-5929
Practice Address - Street 1:2816 VEACH RD
Practice Address - Street 2:SUITE 301
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:270-683-0275
Practice Address - Fax:270-683-5929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60048634Medicaid