Justin Tyler Durancik – General Practice Dentistry

Key facts

NPI: 1982188355
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Dentistry 1223G0001X
License: 019.031786 (IL)
Practice address: 619 E Main St
Genoa, IL 60135-1309
Phone: (815) 784-5166
NPI assigned: Sep 20, 2018
Sex: Male
Sole proprietor: No

Organizations & group practices 2

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

David N McAuslan DDS PC Dental Clinic/Center · Genoa, IL · NPI 1215377031

NPD (past)
Justin T. Durancik, DDS, PLLC Dental Clinic/Center · Genoa, IL · NPI 1932683315

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
019.031786	IL	MD	General Practice Dentistry

Practice roles

Organization	Specialty	Status	New patients
Justin T. Durancik, DDS, PLLC		Past	Accepting new patients
David N McAuslan DDS PC		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Dentistry	1223G0001X	019.031786	IL	Yes

Addresses

Primary practice location

619 E Main St
Genoa, IL 60135-1309

Mailing address

16488 E McNeal Rd
Monroe Center, IL 61052-9719
Phone (815) 761-7159

Other providers in Genoa, IL

All providers in Genoa, IL · General Practice Dentistry in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2018. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.