Provider Demographics
NPI:1114048410
Name:PRUCHNIC, ALBERT BRUCE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:BRUCE
Last Name:PRUCHNIC
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-1636
Mailing Address - Country:US
Mailing Address - Phone:814-467-4474
Mailing Address - Fax:814-467-4474
Practice Address - Street 1:1311 SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-1636
Practice Address - Country:US
Practice Address - Phone:814-467-4474
Practice Address - Fax:814-467-4474
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019291L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011964160001Medicaid