# PETER H PRUDEN, D.D.S., P.C

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114160207
- **Authorized official:** DR. PETER H PRUDEN D.D.S (ORAL SURGEON)
- **Authorized official phone:** (631) 421-2471

## Contact information

- **Practice address:** 124 MAIN ST, SUITE 2, HUNTINGTON, NY 11743-6922
- **Practice address phone:** (631) 421-2471
- **Practice address fax:** (631) 547-6809
- **Mailing address:** 124 MAIN ST, SUITE 2, HUNTINGTON, NY 11743-6922
- **Mailing address phone:** (631) 421-2471
- **Mailing address fax:** (631) 547-6809

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 034661 | NY | Yes |

## Other

- **Enumeration date:** 04/20/2009
- **Last updated:** 04/20/2009