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Organization

MICHAEL J. PURCELL, DDS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL J. PURCELL DDS (OWNER/DENTIST)
(719) 369-8484
Entity
Organization

Contact information

Practice address
1640 FORTINO BLVD, PUEBLO, CO 81008-1856
(719) 543-7123
(719) 253-7761
Mailing address
1640 FORTINO BLVD, PUEBLO, CO 81008-1856
(719) 543-7123
(719) 253-7761

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
C07055
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02070555
CO
01
789815
UNITED CONCORDIA
CO
Enumeration date
01/28/2008
Last updated
01/28/2008
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