MEDICARE: DAVID B PURLEE 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		IL

General Provider Information

NPI Number	:	1437254083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID B PURLEE DDS

Provider Business Mailing Address
First Line	:	630 S EAST ST
Second Line	:
City	:	MOUNT CARROLL
State	:	IL
Zip	:	61053-1459
Country	:	US
Telephone Number	:	815-244-4835
Fax Number	:	815-244-2215

Provider Business Practice Location Address
First Line	:	630 S EAST ST
Second Line	:
City	:	MOUNT CARROLL
State	:	IL
Zip	:	61053-1459
Country	:	US
Telephone Number	:	815-244-4835
Fax Number	:	815-244-2215

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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Directions to “ DAVID B PURLEE DDS” Practice Location

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