Individual
CHANDLER AMY LYNNE PRUITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
100 KINGS FORT PKWY STE 100, KAUFMAN, TX 75142-3544
(469) 414-0670
Mailing address
4001 MARQUETTE ST, DALLAS, TX 75225-5434
(214) 729-9119
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
39261
TX
1223P0221X
Pediatric Dentistry
Primary
39261
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/16/2022
Last updated
10/29/2024
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