MEDICARE: DOUGLAS D DURST DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508080235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS D DURST DDS PC

Provider Business Mailing Address
First Line	:	51 GOODER SIMPSON BLVD NE
Second Line	:	SUITE A
City	:	PIEDMONT
State	:	OK
Zip	:	73078-9237
Country	:	US
Telephone Number	:	405-373-2119
Fax Number	:	405-373-0809

Provider Business Practice Location Address
First Line	:	51 GOODER SIMPSON BLVD NE
Second Line	:	SUITE A
City	:	PIEDMONT
State	:	OK
Zip	:	73978-9237
Country	:	US
Telephone Number	:	405-373-2119
Fax Number	:	405-373-0809

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DOUGLAS D DURST
Credential	:	DDS
Telephone Number	:	405-373-2119

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	04/10/2024

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