MEDICARE: LAWRENCE PURCELL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2973	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063542918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE PURCELL DDS

Provider Business Mailing Address
First Line	:	3800 YORK
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-3972
Country	:	US
Telephone Number	:	303-296-4873
Fax Number	:	303-382-2808

Provider Business Practice Location Address
First Line	:	3800 YORK
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-3972
Country	:	US
Telephone Number	:	303-296-4873
Fax Number	:	303-382-2808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	04/10/2009

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