Healthcare Provider Details

I. General information

NPI: 1427154418
Provider Name (Legal Business Name): MICHAEL J PURCELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 GOODPASTURE ISLAND RD
EUGENE OR
97401-1751
US

IV. Provider business mailing address

12225 VOYAGER PKWY STE 6
COLORADO SPRINGS CO
80921-3754
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-2446
  • Fax: 541-686-3055
Mailing address:
  • Phone: 719-488-4343
  • Fax: 719-694-9036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD10524
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberCO7055
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500711437
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier0207555
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: