Provider Demographics
NPI:1104529122
Name:PURATH, EILIS MAIREAD (DDS)
Entity type:Individual
Prefix:MS
First Name:EILIS
Middle Name:MAIREAD
Last Name:PURATH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 DALE CURTIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:MCFARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-8958
Mailing Address - Country:US
Mailing Address - Phone:608-838-7474
Mailing Address - Fax:608-838-1135
Practice Address - Street 1:4705 DALE CURTIN DRIVE
Practice Address - Street 2:
Practice Address - City:MCFARLAND
Practice Address - State:WI
Practice Address - Zip Code:53558-8958
Practice Address - Country:US
Practice Address - Phone:608-838-7474
Practice Address - Fax:608-838-1135
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001185-151223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program