Dr. Justin Tyler Durancik, DDS
Dentist, General Practice in Genoa, IL. Individual provider (NPI-1).
NPI number1982188355
StatusActive
Last updated in NPPESSep 20, 2018
Details
- NPI
- 1982188355
- Entity type
- Individual (NPI-1)
- Name
- Dr. Justin Tyler Durancik
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 20, 2018
- Last updated
- Sep 20, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 019.031786 | IL | Yes |
Practice location
619 E Main StGenoa, IL 60135-1309
Phone 815-784-5166
Mailing address
16488 E McNeal RdMonroe Center, IL 61052-9719
Phone 815-761-7159
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