Provider Demographics
NPI:1639368145
Name:PURCELL, KAITLYN NGUYEN (DDS)
Entity type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:NGUYEN
Last Name:PURCELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KAILTYN
Other - Middle Name:KIEU
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6003 HONORE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5717
Mailing Address - Country:US
Mailing Address - Phone:941-529-0345
Mailing Address - Fax:
Practice Address - Street 1:6003 HONORE AVE STE 102
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5717
Practice Address - Country:US
Practice Address - Phone:941-529-0345
Practice Address - Fax:941-529-0360
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-21
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA563231223G0001X
NMDD37901223G0001X
FLDN239971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice