Provider Demographics
NPI:1295715233
Name:PURSELL, WAYNE BRUCE (DDS)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:BRUCE
Last Name:PURSELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26789 WOODWARD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1335
Mailing Address - Country:US
Mailing Address - Phone:248-546-0022
Mailing Address - Fax:248-546-6811
Practice Address - Street 1:26789 WOODWARD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1335
Practice Address - Country:US
Practice Address - Phone:248-546-0022
Practice Address - Fax:248-546-6811
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010171621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics