MEDICARE: JOHN LAWRENCE DUREN 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	8764	TX

General Provider Information

NPI Number	:	1831107903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN LAWRENCE DUREN D.D.S.

Provider Business Mailing Address
First Line	:	3812 WOODLAWN AVE
Second Line	:	SUITE B
City	:	PASADENA
State	:	TX
Zip	:	77504-1934
Country	:	US
Telephone Number	:	713-941-5916
Fax Number	:	713-941-4630

Provider Business Practice Location Address
First Line	:	3812 WOODLAWN AVE
Second Line	:	SUITE B
City	:	PASADENA
State	:	TX
Zip	:	77504-1934
Country	:	US
Telephone Number	:	713-941-5916
Fax Number	:	713-941-4630

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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