Justin Tyler Durancik, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.031786 Issued in IL

Practice address

619 E Main St
Genoa, IL 60135-1309

Phone

(815) 784-5166

NPI assigned

Sep 20, 2018

Last updated

Sep 20, 2018By 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.

• Justin T. Durancik, DDS, PLLC

  • Dental Clinic/Center
  • Genoa, IL
  • NPI 1932683315
  NPD (past) Authorized official
• David N McAuslan DDS PC

  dba Genoa Smiles

  • Dental Clinic/Center
  • Genoa, IL
  • NPI 1215377031
  NPD (past)

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

{
    "created_epoch": "1537401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537401600000",
    "number": "1982188355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16488 E MCNEAL RD",
            "city": "MONROE CENTER",
            "state": "IL",
            "postal_code": "610529719",
            "telephone_number": "815-761-7159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 E MAIN ST",
            "city": "GENOA",
            "state": "IL",
            "postal_code": "601351309",
            "telephone_number": "815-784-5166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURANCIK",
        "first_name": "JUSTIN",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-20",
        "last_updated": "2018-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.031786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Ortiz Contreras
• David N McAuslan DDS PC (Genoa Smiles)
• Victoria Elizabeth Deku, M.S. CCC-SLP
• Steven J Disanti, DO
• Dr Hilda Hattar DC PC (Balance Chiropractic & Wellness Center)
• Joshua Benjamin Eriks, DPT
• Family First Physicians SC
• Genesis DTC, LLC
• Genesis Enterprises Inc
• Genoa Kingston Cusd 424

• General Practice Dentistry in Genoa, IL
• Providers in Genoa, 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 Sep 20, 2018; 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.