Provider Demographics
NPI:1497834238
Name:PRYOR, ERIC S (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
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 1:127 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1703
Mailing Address - Country:US
Mailing Address - Phone:706-253-3567
Mailing Address - Fax:706-253-6840
Practice Address - Street 1:127 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1703
Practice Address - Country:US
Practice Address - Phone:706-253-3567
Practice Address - Fax:706-253-6840
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA111451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice