1396940185 NPI number — JOHN D. DURNEY D.D.S., A PROFESSIONAL DENTAL CORPORATION

Table of content: (NPI 1396940185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396940185 NPI number — JOHN D. DURNEY D.D.S., A PROFESSIONAL DENTAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN D. DURNEY D.D.S., A PROFESSIONAL DENTAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396940185
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 YREKA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YREKA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96097-3308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-842-2427
Provider Business Mailing Address Fax Number:
530-841-0733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 YREKA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YREKA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96097-3308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-842-2427
Provider Business Practice Location Address Fax Number:
530-841-0733
Provider Enumeration Date:
06/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DURNEY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
DONALD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
530-842-2427

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  34043 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D34043 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619013323 . This is a "JOHN D. DURNEY NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 34043 . This is a "LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B3404301 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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