Provider Demographics
NPI:1154547644
Name:PURMELL, BRUCE HILARY (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HILARY
Last Name:PURMELL
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 1:843 HAZELWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-2501
Mailing Address - Country:US
Mailing Address - Phone:517-784-2613
Mailing Address - Fax:517-782-9614
Practice Address - Street 1:2002 SPRING ARBOR RD
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-2888
Practice Address - Country:US
Practice Address - Phone:517-782-9533
Practice Address - Fax:517-782-9614
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI142661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice