Provider Demographics
NPI:1679561187
Name:PURCELL, MIGUEL LORENZO (DMD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:LORENZO
Last Name:PURCELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8169 CALLE CONCORDIA
Mailing Address - Street 2:COND. SAN VICENTE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1554
Mailing Address - Country:US
Mailing Address - Phone:787-840-7994
Mailing Address - Fax:787-842-4067
Practice Address - Street 1:8169 CALLE CONCORDIA
Practice Address - Street 2:COND. SAN VICENTE SUITE #4
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1554
Practice Address - Country:US
Practice Address - Phone:787-840-7994
Practice Address - Fax:787-842-4067
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1679561187Medicare PIN