Provider Demographics
NPI:1730260308
Name:PRUITT, GARY ROBIN JR (DMD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ROBIN
Last Name:PRUITT
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2816 COLUMBIANA RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2518
Mailing Address - Country:US
Mailing Address - Phone:205-823-3223
Mailing Address - Fax:205-823-8419
Practice Address - Street 1:2816 COLUMBIANA RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-2518
Practice Address - Country:US
Practice Address - Phone:205-823-3223
Practice Address - Fax:205-823-8419
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL46591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice