Provider Demographics
NPI:1780813691
Name:PRYOR, TRENT (DMD)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:
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 1:1411 FALLS AVE E
Mailing Address - Street 2:SUITE 1000C
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3455
Mailing Address - Country:US
Mailing Address - Phone:208-734-7415
Mailing Address - Fax:208-734-7484
Practice Address - Street 1:1411 FALLS AVE E
Practice Address - Street 2:SUITE 1000C
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3455
Practice Address - Country:US
Practice Address - Phone:208-734-7415
Practice Address - Fax:208-734-7484
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-42171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry