Provider Demographics
NPI:1427154418
Name:PURCELL, MICHAEL J (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:PURCELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12225 VOYAGER PKWY STE 6
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3754
Mailing Address - Country:US
Mailing Address - Phone:719-488-4343
Mailing Address - Fax:719-694-9036
Practice Address - Street 1:748 GOODPASTURE ISLAND RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1751
Practice Address - Country:US
Practice Address - Phone:541-686-2446
Practice Address - Fax:541-686-3055
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORD105241223P0221X
COCO70551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500711437Medicaid
CO0207555Medicaid