Provider Demographics
NPI:1366521965
Name:DURAN, JACK EDWARD (DDS MS LLC)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:EDWARD
Last Name:DURAN
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Gender:M
Credentials:DDS MS LLC
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Mailing Address - Street 1:3601 S CLARKSON ST
Mailing Address - Street 2:#430
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3948
Mailing Address - Country:US
Mailing Address - Phone:303-789-9257
Mailing Address - Fax:303-789-0732
Practice Address - Street 1:3601 S CLARKSON ST
Practice Address - Street 2:#430
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3948
Practice Address - Country:US
Practice Address - Phone:303-789-9257
Practice Address - Fax:303-789-0732
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO74531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31976531Medicaid