Provider Demographics
NPI:1114146941
Name:PURDY, JOHN MARTIN (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARTIN
Last Name:PURDY
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 1:1810 MCRAE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-6706
Mailing Address - Country:US
Mailing Address - Phone:915-593-1833
Mailing Address - Fax:915-592-8441
Practice Address - Street 1:1810 MCRAE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-6706
Practice Address - Country:US
Practice Address - Phone:915-593-1833
Practice Address - Fax:915-592-8441
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice