Provider Demographics
NPI:1265421200
Name:PURCELL, PETER D (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:D
Last Name:PURCELL
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 1:401 POTTERS RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14220-2552
Mailing Address - Country:US
Mailing Address - Phone:716-822-2499
Mailing Address - Fax:716-821-9672
Practice Address - Street 1:401 POTTERS RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14220-2552
Practice Address - Country:US
Practice Address - Phone:716-822-2499
Practice Address - Fax:716-821-9672
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383891223P0221X
NY1223X0400X1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00996694Medicaid