Provider Demographics
NPI:1851602288
Name:PRUTZ, VICTORIA L (DMD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:L
Last Name:PRUTZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27127 CHARDON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1115
Mailing Address - Country:US
Mailing Address - Phone:440-943-1117
Mailing Address - Fax:440-943-9513
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-4751
Practice Address - Fax:717-851-3565
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0236161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice