Provider Demographics
NPI:1467514984
Name:PROUTY, BRIAN K (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:PROUTY
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 1:1304 6TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-1344
Mailing Address - Country:US
Mailing Address - Phone:605-886-8394
Mailing Address - Fax:605-886-5209
Practice Address - Street 1:600 4TH ST NE
Practice Address - Street 2:STE102
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1898
Practice Address - Country:US
Practice Address - Phone:605-886-8394
Practice Address - Fax:605-886-5209
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM983122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist