MEDICARE: MS. EILIS MAIREAD PURATH 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	1223G0001X	General Practice Dentistry	6001185-15	WI

General Provider Information

NPI Number	:	1104529122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EILIS MAIREAD PURATH DDS

Provider Business Mailing Address
First Line	:	4705 DALE CURTIN DRIVE
Second Line	:
City	:	MCFARLAND
State	:	WI
Zip	:	53558-8958
Country	:	US
Telephone Number	:	608-838-7474
Fax Number	:	608-838-1135

Provider Business Practice Location Address
First Line	:	4705 DALE CURTIN DRIVE
Second Line	:
City	:	MCFARLAND
State	:	WI
Zip	:	53558-8958
Country	:	US
Telephone Number	:	608-838-7474
Fax Number	:	608-838-1135

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

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	07/22/2024

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