MEDICARE: DR. CHRISTINA LEIGH PRUITT D.D.S.

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	1223G0001X	General Practice Dentistry	6890	NE

General Provider Information

NPI Number	:	1609191451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA LEIGH PRUITT D.D.S.

Provider Business Mailing Address
First Line	:	5006 UNDERWOOD AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68132-2236
Country	:	US
Telephone Number	:	402-502-7000
Fax Number	:	402-502-7030

Provider Business Practice Location Address
First Line	:	5006 UNDERWOOD AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68132-2236
Country	:	US
Telephone Number	:	402-502-7000
Fax Number	:

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

Provider Enumeration Date	:	04/05/2010
Last Update Date	:	02/02/2021

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