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General NPI Number Information
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NPI Number | 1801240528
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Entity Type | Organization
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Legal Business Name | F. MARION DURST III DMD PC
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 2325 WASHINGTON ROAD
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City | AUGUSTA
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State | GA
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Zip | 30904
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Country | US
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Telephone | 706-736-7146
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Fax |
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Provider Business Mailing Address
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Address Line | 2325 WASHINGTON ROAD
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City | AUGUSTA
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State | GA
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Zip | 30904
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Country | US
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Telephone | 706-736-7146
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Fax |
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Authorized Official
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Title or Position | OM
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Name | JILLIAN HENSON
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Credential |
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Telephone | 706-736-7146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN008119
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License Number State | GA
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