Provider Demographics
NPI:1073779575
Name:PURCELL, BRADLEY A (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:A
Last Name:PURCELL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:55 CAREN AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2515
Mailing Address - Country:US
Mailing Address - Phone:614-885-4401
Mailing Address - Fax:614-888-0284
Practice Address - Street 1:55 CAREN AVE STE 270
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2515
Practice Address - Country:US
Practice Address - Phone:614-885-4401
Practice Address - Fax:614-888-0284
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300226551223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics