Provider Demographics
NPI:1548870884
Name:JURGENS, DANIEL PATRICK (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PATRICK
Last Name:JURGENS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 N COUNTRY CLUB RD STE 2
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-4174
Mailing Address - Country:US
Mailing Address - Phone:217-422-7448
Mailing Address - Fax:
Practice Address - Street 1:2 N COUNTRY CLUB RD STE 2
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-4174
Practice Address - Country:US
Practice Address - Phone:217-422-7448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0327161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice