Provider Demographics
NPI:1306953203
Name:DUNCAN, DEARL C (DDS)
Entity type:Individual
Prefix:
First Name:DEARL
Middle Name:C
Last Name:DUNCAN
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 1:5306 CORTEZ RD W
Mailing Address - Street 2:STE 1
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2821
Mailing Address - Country:US
Mailing Address - Phone:941-792-1440
Mailing Address - Fax:941-798-3569
Practice Address - Street 1:5306 CORTEZ RD W
Practice Address - Street 2:STE 1
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2821
Practice Address - Country:US
Practice Address - Phone:941-792-1440
Practice Address - Fax:941-798-3569
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL85001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL66201OtherBCBS ID
FL66201OtherBCBS ID