Individual
DR. BONITA LYNN PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
US ARMY DENTAL ACTIVITY ATTN CREDENTIALS COORDINATOR, 10205 NORTH RIVA RIDGE LOOP, FORT DRUM, NY 13603-5005
(315) 772-4342
(315) 772-9692
Mailing address
US ARMY DENTAL ACTIVITY ATTN CREDENTIALS COORDINATOR, 10205 NORTH RIVA RIDGE LOOP, FORT DRUM, NY 13603-5005
(315) 772-4342
(315) 772-9692
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
14977
TX
Other
Enumeration date
01/11/2006
Last updated
07/08/2007
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