Provider Demographics
NPI:1285017186
Name:HENRY F. PRUETT, JR., D.D.S., P.A.
Entity Type:Organization
Organization Name:HENRY F. PRUETT, JR., D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:FLOYD
Authorized Official - Last Name:PRUETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:850-476-2552
Mailing Address - Street 1:466 E NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-1441
Mailing Address - Country:US
Mailing Address - Phone:850-476-2552
Mailing Address - Fax:850-479-9861
Practice Address - Street 1:466 E NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-1441
Practice Address - Country:US
Practice Address - Phone:850-476-2552
Practice Address - Fax:850-479-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty