MEDICARE: DR. PHILLIP DURAN 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	1223G0001X	General Practice Dentistry	TX19031	TX

General Provider Information

NPI Number	:	1588778336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP DURAN D.D.S.

Provider Business Mailing Address
First Line	:	3140 W NORTHWEST HWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-5943
Country	:	US
Telephone Number	:	214-904-0220
Fax Number	:

Provider Business Practice Location Address
First Line	:	3140 W NORTHWEST HWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-5943
Country	:	US
Telephone Number	:	214-904-0220
Fax Number	:

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/29/2013

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