Provider Demographics
NPI:1083055867
Name:PURCELL, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:PURCELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2437
Mailing Address - Country:US
Mailing Address - Phone:509-469-6305
Mailing Address - Fax:509-575-3398
Practice Address - Street 1:2205 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-469-6305
Practice Address - Fax:509-575-3398
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND130691223D0001X
WADE608847491223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223D0001XDental ProvidersDentistDental Public Health