Provider Demographics
NPI:1134810021
Name:PURSLEY, THOMAS TRENTON (DMD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:TRENTON
Last Name:PURSLEY
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 1:13057 N LORALEI DR
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-1067
Mailing Address - Country:US
Mailing Address - Phone:928-651-3110
Mailing Address - Fax:
Practice Address - Street 1:2901 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-4706
Practice Address - Country:US
Practice Address - Phone:520-357-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0117731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice