Provider Demographics
NPI:1578657607
Name:PURSELL, GARY D (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:D
Last Name:PURSELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 HIGHWAY 44 E
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6081
Mailing Address - Country:US
Mailing Address - Phone:502-425-4595
Mailing Address - Fax:502-543-3997
Practice Address - Street 1:181 HIGHWAY 44 E
Practice Address - Street 2:SUITE 2
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6081
Practice Address - Country:US
Practice Address - Phone:502-543-3054
Practice Address - Fax:502-543-3997
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY54401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice