Healthcare Provider Details

I. General information

NPI: 1104168020
Provider Name (Legal Business Name): PAUL PRYOR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 09/02/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 3215, 86 MDG RAMSTEIN AB
APO AE
09094
US

IV. Provider business mailing address

86 MDG, UNIT 3215 RAMSTEIN AB
APO AE
09094
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-2210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS039594
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: