Healthcare Provider Details

I. General information

NPI: 1164339172
Provider Name (Legal Business Name): PURIFY DENTAL OF ROSWELL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 N SCENIC DR
ALAMOGORDO NM
88310-4304
US

IV. Provider business mailing address

780 N SCENIC DR
ALAMOGORDO NM
88310-4304
US

V. Phone/Fax

Practice location:
  • Phone: 575-437-8994
  • Fax:
Mailing address:
  • Phone: 575-437-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: GAURAV PURI
Title or Position: OWNER/DENTIST
Credential:
Phone: 575-437-8994