Healthcare Provider Details

I. General information

NPI: 1417122482
Provider Name (Legal Business Name): JOHN E PURPURA DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300-306 BOLOUN CENTER
ST JOHN US VIRGIN ISLAND
00831
UM

IV. Provider business mailing address

PO BOX 8326 300-306 BOLOUN CENTER
ST JOHN US VIRGIN ISLAND
00831
UM

V. Phone/Fax

Practice location:
  • Phone: 340-693-8898
  • Fax:
Mailing address:
  • Phone: 340-693-8898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number1254
License Number StateVI

VIII. Authorized Official

Name: JOHN EDWARD PURPURA
Title or Position: OWNER/PERSIDENT/DENTIST
Credential: DDS
Phone: 340-693-8898