Provider Demographics
NPI:1932683315
Name:JUSTIN T. DURANCIK, DDS, PLLC
Entity Type:Organization
Organization Name:JUSTIN T. DURANCIK, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:DURANCIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-761-7159
Mailing Address - Street 1:16488 E MCNEAL RD
Mailing Address - Street 2:
Mailing Address - City:MONROE CENTER
Mailing Address - State:IL
Mailing Address - Zip Code:61052-9719
Mailing Address - Country:US
Mailing Address - Phone:815-761-7159
Mailing Address - Fax:
Practice Address - Street 1:619 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:IL
Practice Address - Zip Code:60135-1309
Practice Address - Country:US
Practice Address - Phone:815-784-5166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental