Provider Demographics
NPI:1477191047
Name:PURSEL, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:PURSEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 E CEDARVILLE RD
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-7626
Mailing Address - Country:US
Mailing Address - Phone:484-919-5059
Mailing Address - Fax:
Practice Address - Street 1:1510 CHESTER PIKE STE 200
Practice Address - Street 2:
Practice Address - City:EDDYSTONE
Practice Address - State:PA
Practice Address - Zip Code:19022-1377
Practice Address - Country:US
Practice Address - Phone:610-485-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-14
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DH013040L124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist