Provider Demographics
NPI:1841688199
Name:DURALL, ANTHONY W (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:W
Last Name:DURALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics