Provider Demographics
NPI:1437117801
Name:PRUCE, ROBERT L (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:PRUCE
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 1:2010 TALL GRASS LN UNIT 311
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-4725
Mailing Address - Country:US
Mailing Address - Phone:412-480-6765
Mailing Address - Fax:
Practice Address - Street 1:900 WILDFLOWER CIR STE 904
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9782
Practice Address - Country:US
Practice Address - Phone:724-942-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-029866-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018339400001Medicaid