Provider Demographics
NPI:1114042330
Name:PRUHS, MATTHEW THOMAS
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:PRUHS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W178N9201 WATERTOWER PLACE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051
Mailing Address - Country:US
Mailing Address - Phone:262-251-8704
Mailing Address - Fax:262-251-8341
Practice Address - Street 1:W178N9201 WATERTOWER PLACE
Practice Address - Street 2:SUITE 100
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051
Practice Address - Country:US
Practice Address - Phone:262-251-8704
Practice Address - Fax:262-251-8341
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI01553341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice