Individual
MR. NICOLAS ROGER PRUETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DD.S.
Contact information
Practice address
1930 S. NEVADA AVE, COLORADO SPRINGS, CO 80905-3407
(719) 576-5566
(719) 576-1100
Mailing address
1930 S. NEVADA AVE, COLORADO SPRINGS, CO 80905-3407
(719) 576-5566
(719) 576-1100
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8913
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
193616
BLUE CROSS VIRGINIA
CO
01
—
886687
UNITED CONCORDIA PROVIDER
CO
Enumeration date
09/17/2006
Last updated
08/13/2010
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