Provider Demographics
NPI:1124185798
Name:PROSPER, TRUIT R (DDS)
Entity Type:Individual
Prefix:
First Name:TRUIT
Middle Name:R
Last Name:PROSPER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 WISCONSIN AVENUE NW
Mailing Address - Street 2:SUITE 112
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 WISCONSIN AVENUE NW
Practice Address - Street 2:SUITE 112
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-4528
Practice Address - Country:US
Practice Address - Phone:202-333-6569
Practice Address - Fax:202-333-2195
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC48581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice