Daniel Patrick Jurgens, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.032716 Issued in IL

Practice address

2 N Country Club Rd Ste 2
Decatur, IL 62521-4174

Phone

(217) 422-7448

NPI assigned

Aug 2, 2020

Last updated

Aug 2, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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.

• Medora Dental LLC

  • Dental Clinic/Center
  • Decatur, IL
  • NPI 1629945357
  NPD Authorized official

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

{
    "created_epoch": "1596326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596326400000",
    "number": "1548870884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 N COUNTRY CLUB RD STE 2",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625214174",
            "telephone_number": "217-422-7448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 N COUNTRY CLUB RD STE 2",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625214174",
            "telephone_number": "217-422-7448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JURGENS",
        "first_name": "DANIEL",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-02",
        "last_updated": "2020-08-02",
        "certification_date": "2020-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.032716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaylon Christopher Joyner
• JSP Lap, LLC
• Jurgens & Kneezel LTD
• Alan Russell Jurgens, DDS
• Carl Edward Jurgens, DDS
• K M B S C
• Yannick Kadia, MD
• Jeanne Marie Kairouz, MD
• Sebastien Simon Kairouz, M.D.
• Kaloupek Counseling, LLC (Renewed Hope Counseling)

• General Practice Dentistry in Decatur, IL
• Providers in Decatur, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2020; 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.