Individual
DUSTIN DURNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17490 STATE ROAD 23, SOUTH BEND, IN 46635-1743
(574) 271-9000
Mailing address
17490 STATE ROAD 23, SOUTH BEND, IN 46635-1743
(574) 271-9000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12013563A
IN
Other
Enumeration date
06/05/2018
Last updated
05/31/2023
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