Individual
DR. JOHN MICHAEL DURUSSEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
30960 STAGECOACH BLVD STE W100, EVERGREEN, CO 80439-7902
(303) 674-1122
Mailing address
6992 LYNX LAIR RD, EVERGREEN, CO 80439
(989) 284-4581
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DEN.00202186
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
62350277
—
CO
01
—
DEN.00202186
CO DENTAL LICENSE
CO
Enumeration date
04/02/2014
Last updated
03/18/2021
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