Provider Demographics
NPI:1457485195
Name:PRYOR, DENNIS PHILIP (DMD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:PHILIP
Last Name:PRYOR
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 1:6592 ELLIES WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-1874
Mailing Address - Country:US
Mailing Address - Phone:703-250-0595
Mailing Address - Fax:
Practice Address - Street 1:7493 HUNTSMAN BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22153-1648
Practice Address - Country:US
Practice Address - Phone:703-455-1505
Practice Address - Fax:703-455-4285
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010071881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics