Provider Demographics
NPI:1750019535
Name:IRONS, CAROLINE PRUITT
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:PRUITT
Last Name:IRONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 BRANBURY CT
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8019
Mailing Address - Country:US
Mailing Address - Phone:601-325-6319
Mailing Address - Fax:
Practice Address - Street 1:1529 S TIMESQUARE LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-8201
Practice Address - Country:US
Practice Address - Phone:208-343-1981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-54401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice