DR. BONITA LYNN PRUITT (NPI# 1770562415) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770562415 |
| Entity Type | Individual |
| Full Name | DR. BONITA LYNN PRUITT |
| Credential | DDS |
| Practice Address |
Us Army Dental Activity Attn Credentials Coordinator 10205 North Riva Ridge Loop Fort Drum NY 13603-5005 |
| Practice Telephone | 3157724342 |
| Practice Fax Number | 3157729692 |
| Mailing Telephone | 3157724342 |
| Mailing Fax Number | 3157729692 |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
14977 | TX | Dental Providers |
| Street Address |
US ARMY DENTAL ACTIVITY ATTN CREDENTIALS COORDINATOR 10205 NORTH RIVA RIDGE LOOP |
| City | FORT DRUM |
| State | NY |
| Zip Code | 13603-5005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316920705 | David Lee Schneck | Dentist | Us Army Dental Activity Attn Credentials Coordinator, 10205 N Riva Ridge Loop, Fort Drum, NY 13602-5005 | 2005-11-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265915391 | Bryan Dylan Wheeler | Military Health Care Provider | Us Army, Ctmc, Fort Drum, NY 13603 | 2018-09-14 |
| 1568849628 | Usv Optical Inc. | Eyewear Supplier (Equipment, not the service) | Enduring Freedom Dr, Bldg. P-10730 A/b, Ft. Drum, NY 13603 | 2015-04-28 |
| 1053687400 | Renatta C Sears | Licensed Practical Nurse | 8533 Spraight Loop, Apt G, Fort Drum, NY 13603 | 2012-03-30 |
| 1043497910 | Michelle Marie Chavez | Licensed Practical Nurse | 10807 B St.vith Way, Fort Drum, NY 13603 | 2008-01-23 |
| 1003358284 | Kaliope Goutis | Nursing Care | 8323e Middle Lewis Ave, Fort Drum, NY 13603-2024 | 2016-11-05 |
| 1285821967 | Jean Marie Anderson | Physical Therapist | 6671a Wildwood Dr, Fort Drum, NY 13603-2053 | 2007-09-26 |
| 1790268589 | Autumn Skye Duebbe | Registered Nurse | 6337a Edgewood Dr, Fort Drum, NY 13603-2056 | 2018-09-08 |
| 1932580875 | Brittany Grome | Licensed Practical Nurse | 6349b Highland Dr, Fort Drum, NY 13603-2057 | 2015-06-16 |
| 1205076643 | Mary June Robison | Licensed Practical Nurse | 6420b Winterhaven Dr, Fort Drum, NY 13603-2063 | 2009-02-25 |
| 1659910370 | Helping Hands Concierge, LLC | Non-emergency Medical Transport (VAN) | 6145a Meadow Wood Dr, Fort Drum, NY 13603-2077 | 2019-12-27 |
| Find all providers in zip 13603 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417557059 | Smiles and Grins Pediatric Dentistry | Dentist | 160 E 88th St Apt 1d, New York, NY 10128-2217 | 2020-10-30 |
| 1891395810 | Ez Orthodontics Pllc | Dentist | 4010 82nd St Fl 2, Elmhurst, NY 11373-1305 | 2020-10-28 |
| 1346858677 | Kids Dental of Queens PC | Dentist | 4236 82nd St # C, Elmhurst, NY 11373-3537 | 2020-07-22 |
| 1073131512 | Prohealth Dental Pllc | Dentist | 2318 31st St Ste 320, Astoria, NY 11105-2765 | 2020-07-10 |
| 1952929911 | Kiddsmiles Pediatric Dentistry 7 Pllc | Dentist | 263 Jericho Tpke, Floral Park, NY 11001-2146 | 2020-07-07 |
| 1376177782 | Pco Ortho LLC | Dentist | 3422 35th St, Long Island City, NY 11106-1268 | 2020-02-24 |
| 1033749916 | Yehuda Marciano Dds PC | Dentist | 932 Broadway Ste 1, Woodmere, NY 11598-1723 | 2020-01-20 |
| 1710521752 | Asnis Dental Pllc | Dentist | 800 N Broadway, Massapequa, NY 11758-2335 | 2019-11-02 |
| 1760026777 | Dr. Stephen A Festa-pediatric Dentistry Pllc | Dentist | 3755 76th St Bsmt Apt, Jackson Heights, NY 11372-6552 | 2019-11-01 |
| 1841849965 | Woodrow Little Smiles Family Dentistry P.C. | Dentist | 739 Woodrow Road, Staten Island, NY 10312 | 2019-09-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.