Healthcare Provider Details

I. General information

NPI: 1083031264
Provider Name (Legal Business Name): DURK IRWIN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 SW DORION AVE
PENDLETON OR
97801-2037
US

IV. Provider business mailing address

610 SW DORION AVE
PENDLETON OR
97801-2037
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-7819
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD6991
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: