Provider Demographics
NPI:1043504046
Name:PURVIS DENTISTRY, PC
Entity Type:Organization
Organization Name:PURVIS DENTISTRY, PC
Other - Org Name:VESTAVIA HILLS PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FLYNT
Authorized Official - Middle Name:GILBERT
Authorized Official - Last Name:PURVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-874-6206
Mailing Address - Street 1:2401 DOLLY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-4609
Mailing Address - Country:US
Mailing Address - Phone:205-983-8980
Mailing Address - Fax:
Practice Address - Street 1:2401 DOLLY RIDGE RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-4609
Practice Address - Country:US
Practice Address - Phone:205-983-8980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL56071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty