Basic Information
| Provider Information | |||||||||
| NPI: | 1437111754 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURKAN | ||||||||
| FirstName: | MARCIA | ||||||||
| MiddleName: | ADAMS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MUZZI | ||||||||
| OtherFirstName: | MARCIA | ||||||||
| OtherMiddleName: | ADAMS | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DMD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9874 YAMATO RD STE 116 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334345552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614881688 | ||||||||
| FaxNumber: | 5614771002 | ||||||||
| Practice Location | |||||||||
| Address1: | 9874 YAMATO RD STE 116 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334345552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614881688 | ||||||||
| FaxNumber: | 5614771002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 11/04/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DS021845 | PA | N | Dental Providers | Dentist | 1223G0001X | DN18759 | FL | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 0008633180008 | 05 | PA | MEDICAID | 0008633180005 | 05 | PA | MEDICAID | 0008633180018 | 05 | PA | MEDICAID | 0008633180003 | 05 | PA | MEDICAID | 0008633180004 | 05 | PA | MEDICAID | 0008633180016 | 05 | PA | MEDICAID | 0008633180017 | 05 | PA | MEDICAID | 0008633180020 | 05 | PA | MEDICAID | 0008633180015 | 05 | PA | MEDICAID | 0008633180007 | 05 | PA | MEDICAID | 0008633180019 | 05 | PA | MEDICAID | 0008633180006 | 05 | PA | MEDICAID | 0008633180013 | 05 | PA | MEDICAID |