Provider Demographics
NPI:1154720191
Name:PURCELL, JUDITH A (DDS)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:A
Last Name:PURCELL
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 1:721 HOOSICK ROAD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-8823
Mailing Address - Country:US
Mailing Address - Phone:518-273-0737
Mailing Address - Fax:518-273-0149
Practice Address - Street 1:721 HOOSICK ROAD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180
Practice Address - Country:US
Practice Address - Phone:518-273-0737
Practice Address - Fax:518-273-0149
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0352481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice