Active NPI
Brent Byron Pursifull, DMD
- General Practice Dentistry
- Middlesboro, KY
National Provider Identifier
1992880371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6356
- Practice address
- 3602 W Cumberland Ave
Middlesboro, KY 40965 - Phone
- (606) 248-2328
- Fax
- (606) 248-2536
- NPI assigned
- Oct 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6356 | KY | Primary |
Addresses
Primary practice location
3602 W Cumberland Ave
Middlesboro, KY 40965
Mailing address
PO Box 2297
Middlesboro, KY 40965
Phone (606) 248-2328
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60063567 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6356 | KY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992880371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2297",
"city": "MIDDLESBORO",
"state": "KY",
"postal_code": "40965",
"telephone_number": "606-248-2328",
"fax_number": "606-248-2536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3602 W CUMBERLAND AVE",
"city": "MIDDLESBORO",
"state": "KY",
"postal_code": "40965",
"telephone_number": "606-248-2328",
"fax_number": "606-248-2536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PURSIFULL",
"first_name": "BRENT",
"middle_name": "BYRON",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KY",
"license": "6356",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60063567",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Middlesboro, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.