Organization
CHEYENNE MOUNTAIN CHILDREN'S DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J. PURCELL DDS (OWNER/DENTIST)
(719) 442-1960
Entity
Organization
Contact information
Practice address
6514 S ACADEMY BLVD, COLORADO SPRINGS, CO 80906-8614
(719) 442-1960
Mailing address
6514 S ACADEMY BLVD, COLORADO SPRINGS, CO 80906
(719) 442-1960
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
7055
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000789815
UNITED CONCORIDA
CO
05
—
0207555
—
CO
Enumeration date
06/30/2008
Last updated
06/30/2008
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