Provider Demographics
NPI:1659321909
Name:PURVIS, DANIEL E (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:PURVIS
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 1:3628 N SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-1436
Mailing Address - Country:US
Mailing Address - Phone:317-545-6011
Mailing Address - Fax:317-541-2786
Practice Address - Street 1:3628 N SHERMAN DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-1436
Practice Address - Country:US
Practice Address - Phone:317-545-6011
Practice Address - Fax:317-541-2786
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009608B122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist