1568676856 NPI number — DR. DANIEL CLAY PURSWELL DDS

Table of content: DR. DANIEL CLAY PURSWELL DDS (NPI 1568676856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568676856 NPI number — DR. DANIEL CLAY PURSWELL DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PURSWELL
Provider First Name:
DANIEL
Provider Middle Name:
CLAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568676856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4005 DAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN MARCOS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78666-9539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-396-1244
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GARY JOB CORPS,
Provider Second Line Business Practice Location Address:
2800 AIRPORT, HWY 21
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-396-6640
Provider Business Practice Location Address Fax Number:
512-396-6872
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  13389 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 13389 . This is a "STATE BOARD #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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