Provider Demographics
NPI:1164453072
Name:PURINSH, MARY ANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANNA
Last Name:PURINSH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 W. COLORADO AVE.
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904
Mailing Address - Country:US
Mailing Address - Phone:719-633-0999
Mailing Address - Fax:719-633-3414
Practice Address - Street 1:1330 W. COLORADO AVE.
Practice Address - Street 2:#211
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904
Practice Address - Country:US
Practice Address - Phone:719-633-0999
Practice Address - Fax:719-633-3414
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO1045691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02045698Medicaid