Basic Information
| Provider Information | |||||||||
| NPI: | 1821142050 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PURCELL | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PURCELL | ||||||||
| OtherFirstName: | ALLISON | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | DDS | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1612 HUGUENOT ROAD | ||||||||
| Address2: | |||||||||
| City: | MIDLOTHIAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047949789 | ||||||||
| FaxNumber: | 8047949762 | ||||||||
| Practice Location | |||||||||
| Address1: | 6353 MECHANICSVILLE TPKE | ||||||||
| Address2: | |||||||||
| City: | MECHANICSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047303400 | ||||||||
| FaxNumber: | 8045594995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 12/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 0401410375 | VA | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.