Provider Demographics
NPI:1205815958
Name:PRUETT, NANCY K (DDS)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:K
Last Name:PRUETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 STATESMEN DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-5642
Mailing Address - Country:US
Mailing Address - Phone:317-255-4447
Mailing Address - Fax:
Practice Address - Street 1:4715 STATESMEN DR
Practice Address - Street 2:SUITE G
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-5642
Practice Address - Country:US
Practice Address - Phone:317-255-4447
Practice Address - Fax:317-255-4427
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120082171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice