Provider Demographics
NPI:1083827117
Name:PURK, JEFFERY (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:PURK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 SW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-3909
Mailing Address - Country:US
Mailing Address - Phone:515-287-3588
Mailing Address - Fax:515-287-7614
Practice Address - Street 1:4405 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-3909
Practice Address - Country:US
Practice Address - Phone:515-287-3588
Practice Address - Fax:515-287-7614
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA75661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice