Provider Demographics
NPI:1013414994
Name:G. ROBIN PRUITT, JR., D.M.D. PC
Entity Type:Organization
Organization Name:G. ROBIN PRUITT, JR., D.M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:AINSLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-823-3223
Mailing Address - Street 1:2816 COLUMBIANA RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2518
Mailing Address - Country:US
Mailing Address - Phone:205-823-3223
Mailing Address - Fax:
Practice Address - Street 1:2816 COLUMBIANA RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-2518
Practice Address - Country:US
Practice Address - Phone:205-823-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty