Provider Demographics
NPI:1417397068
Name:PURCELL, STEFANI (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEFANI
Middle Name:
Last Name:PURCELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5719 W BENT TREE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-9365
Mailing Address - Country:US
Mailing Address - Phone:623-326-8725
Mailing Address - Fax:
Practice Address - Street 1:2217 W HAPPY VALLEY RD
Practice Address - Street 2:STE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-1603
Practice Address - Country:US
Practice Address - Phone:623-792-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0087381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice