Provider Demographics
NPI:1174945596
Name:DAVID J PURDY DDS, PC
Entity type:Organization
Organization Name:DAVID J PURDY DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:PURDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-364-4496
Mailing Address - Street 1:809 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045-4001
Mailing Address - Country:US
Mailing Address - Phone:806-364-4496
Mailing Address - Fax:806-364-4981
Practice Address - Street 1:809 W PARK AVE
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045-4001
Practice Address - Country:US
Practice Address - Phone:806-364-4496
Practice Address - Fax:806-364-4981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX136741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty