MEDICARE: CARSON ALEXANDER PRUITT DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D-0006891-C1	AL

General Provider Information

NPI Number	:	1487222840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARSON ALEXANDER PRUITT DMD

Provider Business Mailing Address
First Line	:	2117 1ST AVE N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-4201
Country	:	US
Telephone Number	:	205-238-6800
Fax Number	:	205-322-6100

Provider Business Practice Location Address
First Line	:	2117 1ST AVE N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-4201
Country	:	US
Telephone Number	:	205-238-6800
Fax Number	:	205-322-6100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	02/21/2024

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