Dustin Durnell

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12013563A Issued in IN

Practice address

17490 State Road 23
South Bend, IN 46635-1743

Phone

(574) 271-9000

NPI assigned

Jun 5, 2018

Last updated

May 31, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jeffrey S. Mader, DDS, LLC

  • Dentist
  • South Bend, IN
  • NPI 1841627783
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685491200000",
    "number": "1528550688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17490 STATE ROAD 23",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351743",
            "telephone_number": "574-271-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17490 STATE ROAD 23",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351743",
            "telephone_number": "574-271-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURNELL",
        "first_name": "DUSTIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-05",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12013563A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Dunn, MS, LCSW, LMHC, LMFT
• Gerard I Duprat, MD
• Matthew T. Dupre, MD
• Edward J Durbin, MD
• Timothy J Durham, MD
• Brendan Thomas Durr
• Erica Durst
• Amanda Kathrine Willems Dutkiewicz, M.D.
• Gisselle Dwyer, MSED
• Melinda Millan Dy, D.O.

• General Practice Dentistry in South Bend, IN
• Providers in South Bend, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.