Individual
AMY KATHLEEN PRUETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
8931 SE FOSTER RD, PORTLAND, OR 97266-4661
(855) 433-6825
Mailing address
6950 NE CAMPUS WAY, HILLSBORO, OR 97124-5611
(855) 433-6825
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D9934
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689006439
NPI
—
01
—
D9934
OREGON DENTAL LICENSE
—
Enumeration date
08/04/2013
Last updated
03/11/2025
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