Provider Demographics
NPI:1770852741
Name:PURCELL, MICHAEL VINCENT (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:VINCENT
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:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63016-0537
Mailing Address - Country:US
Mailing Address - Phone:636-285-2648
Mailing Address - Fax:
Practice Address - Street 1:923 MANSIONHILL DR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2821
Practice Address - Country:US
Practice Address - Phone:636-285-2648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics