Provider Demographics
NPI:1922182005
Name:PURDY, MARC (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:PURDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9751
Mailing Address - Country:US
Mailing Address - Phone:607-266-9714
Mailing Address - Fax:607-272-7516
Practice Address - Street 1:1018 ELLIS HOLLOW RD
Practice Address - Street 2:SUITE A
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-2808
Practice Address - Country:US
Practice Address - Phone:607-272-2040
Practice Address - Fax:607-272-7516
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0418841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice