Provider Demographics
NPI:1417122482
Name:JOHN E PURPURA DDS PC
Entity Type:Organization
Organization Name:JOHN E PURPURA DDS PC
Other - Org Name:ST JOHN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PERSIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PURPURA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:340-693-8898
Mailing Address - Street 1:PO BOX 8326
Mailing Address - Street 2:300-306 BOLOUN CENTER
Mailing Address - City:ST JOHN
Mailing Address - State:US VIRGIN ISLAND
Mailing Address - Zip Code:00831
Mailing Address - Country:UM
Mailing Address - Phone:340-693-8898
Mailing Address - Fax:
Practice Address - Street 1:300-306 BOLOUN CENTER
Practice Address - Street 2:
Practice Address - City:ST JOHN
Practice Address - State:US VIRGIN ISLAND
Practice Address - Zip Code:00831
Practice Address - Country:UM
Practice Address - Phone:340-693-8898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1254261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental