Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 964 | WY |
N | 1223X0400X | Orthodontists | 964 | WY |
NPI | 1003921735 |
---|---|
Provider Name | Denise R Prugh |
First Address | Casper, WY 82609-1911 |
Second Address | Casper, WY 82609-1911 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |