Provider Demographics
NPI:1841387511
Name:PURSEL, KEVIN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:PURSEL
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 1:647 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-2140
Mailing Address - Country:US
Mailing Address - Phone:814-535-5244
Mailing Address - Fax:814-536-2474
Practice Address - Street 1:647 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-2140
Practice Address - Country:US
Practice Address - Phone:814-535-5244
Practice Address - Fax:814-536-2474
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029190L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice