Healthcare Provider Details

I. General information

NPI: 1508080235
Provider Name (Legal Business Name): DOUGLAS D DURST DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 GOODER SIMPSON BLVD NE SUITE A
PIEDMONT OK
73978-9237
US

IV. Provider business mailing address

51 GOODER SIMPSON BLVD NE SUITE A
PIEDMONT OK
73078-9237
US

V. Phone/Fax

Practice location:
  • Phone: 405-373-2119
  • Fax: 405-373-0809
Mailing address:
  • Phone: 405-373-2119
  • Fax: 405-373-0809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS D DURST
Title or Position: DENTIST
Credential: DDS
Phone: 405-373-2119