Provider Demographics
NPI:1851824460
Name:PURCELL, ANNE (DMD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:PURCELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:PURCELL
Other - Last Name:FARHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 WILLOWBROOK LN STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5594
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 SE 3RD AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4019
Practice Address - Country:US
Practice Address - Phone:503-213-2157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD109291223G0001X, 1223P0221X
PADS0431051223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500767313Medicaid