Organization
ELISE PRUETT DDS PLLC
Active
Other names
Coppell Heritage Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
ELISE ELAINE PRUETT DDS (OWNER)
(972) 304-0891
Entity
Organization
Contact information
Practice address
301 S DENTON TAP RD, STE 110, COPPELL, TX 75019
(972) 304-0891
(972) 304-0893
Mailing address
301 S DENTON TAP RD, STE 110, COPPELL, TX 75019
(972) 304-0891
(972) 304-0893
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
28899
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558791004
NPI TYPE 1
TX
Enumeration date
08/31/2016
Last updated
08/31/2016
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