Healthcare Provider Details

I. General information

NPI: 1033328349
Provider Name (Legal Business Name): JURGENS & KNEEZEL LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 W MAIN STREET
DECATUR IL
62522
US

IV. Provider business mailing address

334 W MAIN STREET
DECATUR IL
62522
US

V. Phone/Fax

Practice location:
  • Phone: 217-428-4683
  • Fax: 217-428-4738
Mailing address:
  • Phone: 217-428-4683
  • Fax: 217-428-4738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. CARL E JURGENS
Title or Position: SECRETARY TREASURER
Credential: DDS
Phone: 217-428-4685