Healthcare Provider Details

I. General information

NPI: 1831252162
Provider Name (Legal Business Name): ANTHONY W DURALL DMD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 VEACH RD SUITE 301
OWENSBORO KY
42303
US

IV. Provider business mailing address

2816 VEACH RD SUITE 301
OWENSBORO KY
42303
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-0275
  • Fax: 270-683-5929
Mailing address:
  • Phone: 270-683-0275
  • Fax: 270-683-5929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4863
License Number StateKY

VIII. Authorized Official

Name: DR. ANTHONY W DURALL
Title or Position: PRESIDENT
Credential: DMDD
Phone: 270-683-0275