Healthcare Provider Details

I. General information

NPI: 1376764209
Provider Name (Legal Business Name): DURELL & DURELL DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 AGAN DR
PLAINFIELD IN
46168-7715
US

IV. Provider business mailing address

PO BOX 236
PLAINFIELD IN
46168-0236
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-6106
  • Fax:
Mailing address:
  • Phone: 317-839-6106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12009474
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DAVID K DURELL
Title or Position: OWNER
Credential: DDS
Phone: 317-839-6106