MEDICARE: PURE DENTAL AND IMPLANT CENTER, PLLC

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

General Provider Information

NPI Number	:	1205382652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURE DENTAL AND IMPLANT CENTER, PLLC

Provider Business Mailing Address
First Line	:	2006 N GARLAND AVE
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-3302
Country	:	US
Telephone Number	:	972-530-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2006 N GARLAND AVE
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-3302
Country	:	US
Telephone Number	:	972-530-8800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JONATHAN A KUIPERS
Credential	:
Telephone Number	:	972-530-8800

Provider Enumeration Date	:	08/26/2016
Last Update Date	:	08/26/2016

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