Provider Demographics
NPI:1639368145
Name:PURCELL, KAITLYN NGUYEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:NGUYEN
Last Name:PURCELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KAILTYN
Other - Middle Name:KIEU
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3100 SW 62 AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155
Mailing Address - Country:US
Mailing Address - Phone:305-669-5873
Mailing Address - Fax:
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-669-5873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-21
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA563231223G0001X
NMDD37901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice