# PRUDEN FAMILY DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** P MILTON COOK PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1972261527
- **Legal business name:** P MILTON COOK PC
- **Authorized official:** DONNA RENEE JOHNSON (GENERAL MANAGER)
- **Authorized official phone:** (757) 357-4121

## Contact information

- **Practice address:** 2303 PRUDEN BLVD, SUFFOLK, VA 23434-4330
- **Practice address phone:** (757) 539-9481
- **Mailing address:** 2303 PRUDEN BLVD, SUFFOLK, VA 23434-4330
- **Mailing address phone:** (757) 539-9481

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/01/2021
- **Last updated:** 12/01/2021