Provider Demographics
NPI:1124431259
Name:DURBIN, BRETT T (DDS)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:T
Last Name:DURBIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 E KEARNEY STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803
Mailing Address - Country:US
Mailing Address - Phone:417-862-4192
Mailing Address - Fax:417-862-5469
Practice Address - Street 1:2235 E KEARNEY STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803
Practice Address - Country:US
Practice Address - Phone:417-862-4192
Practice Address - Fax:417-862-5469
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140167941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice