Healthcare Provider Details

I. General information

NPI: 1184796781
Provider Name (Legal Business Name): DURK V IRWIN DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 SW DORION AVE
PENDLETON OR
97801
US

IV. Provider business mailing address

610 SW DORION AVE
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-7819
  • Fax: 541-278-2563
Mailing address:
  • Phone: 541-276-7819
  • Fax: 541-278-2563

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: DR. DURK V IRWIN
Title or Position: PRESIDENT
Credential: DMD PC
Phone: 541-276-7819