# ELISE PRUETT DDS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Coppell Heritage Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568918373
- **Authorized official:** ELISE ELAINE PRUETT DDS (OWNER)
- **Authorized official phone:** (972) 304-0891

## Contact information

- **Practice address:** 301 S DENTON TAP RD, STE 110, COPPELL, TX 75019
- **Practice address phone:** (972) 304-0891
- **Practice address fax:** (972) 304-0893
- **Mailing address:** 301 S DENTON TAP RD, STE 110, COPPELL, TX 75019
- **Mailing address phone:** (972) 304-0891
- **Mailing address fax:** (972) 304-0893

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 28899 | TX | Yes |

## Other

- **Enumeration date:** 08/31/2016
- **Last updated:** 08/31/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1558791004 | NPI TYPE 1 | TX |