Provider Demographics
NPI:1821727520
Name:RYAN T. PRUITT, D.M.D & ASSOCIATES P.A.
Entity Type:Organization
Organization Name:RYAN T. PRUITT, D.M.D & ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:252-756-3313
Mailing Address - Street 1:2446 EMERALD PL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5784
Mailing Address - Country:US
Mailing Address - Phone:252-756-3313
Mailing Address - Fax:252-756-0146
Practice Address - Street 1:2446 EMERALD PL
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5784
Practice Address - Country:US
Practice Address - Phone:252-756-3313
Practice Address - Fax:252-756-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1487832960OtherLLC