Provider Demographics
NPI:1922164375
Name:PURK, JOHN HENRY (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HENRY
Last Name:PURK
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 N CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-5321
Mailing Address - Country:US
Mailing Address - Phone:913-961-8204
Mailing Address - Fax:
Practice Address - Street 1:2109 CUMING ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-4325
Practice Address - Country:US
Practice Address - Phone:402-280-5990
Practice Address - Fax:402-280-5013
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO126671223G0001X
KS54061223G0001X
NE7501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice