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General NPI Number Information
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NPI Number | 1538275284
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Entity Type | Organization
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Legal Business Name | DURBIN DENTAL
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 01/17/2012
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Provider Practice Location Address
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Address Line | 610 N MILES ST
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701
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Country | US
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Telephone | 270-763-6604
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Fax | 270-763-6552
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Provider Business Mailing Address
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Address Line | 610 N MILES ST
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701
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Country | US
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Telephone | 270-763-6604
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Fax | 270-763-6552
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DEREK PRICE DURBIN
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Credential | DMD
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Telephone | 270-763-6604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7251
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License Number State | KY
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