MEDICARE: JESSICA LYNN DURU D.D.S.

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	122300000X	Dentist	10434	CO

General Provider Information

NPI Number	:	1538452420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LYNN DURU D.D.S.

Provider Business Mailing Address
First Line	:	6665 DELMONICO DR
Second Line	:	SUITE # C
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-6801
Country	:	US
Telephone Number	:	719-599-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	6665 DELMONICO DR
Second Line	:	SUITE # C
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-6801
Country	:	US
Telephone Number	:	719-599-5700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	08/04/2015

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