Provider Demographics
NPI:1144517731
Name:VAKIL, PURVI (DDS)
Entity type:Individual
Prefix:
First Name:PURVI
Middle Name:
Last Name:VAKIL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 GROSSMONT CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3074
Mailing Address - Country:US
Mailing Address - Phone:951-756-3767
Mailing Address - Fax:
Practice Address - Street 1:5601 GROSSMONT CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3074
Practice Address - Country:US
Practice Address - Phone:951-756-3767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60467122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist