Healthcare Provider Details

I. General information

NPI: 1831208511
Provider Name (Legal Business Name): ROBERT LEE PRYOR DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 EAST DIVISION ROAD
OAK RIDGE TN
37830
US

IV. Provider business mailing address

126 EAST DIVISION ROAD
OAK RIDGE TN
37830
US

V. Phone/Fax

Practice location:
  • Phone: 865-481-0008
  • Fax: 865-481-0695
Mailing address:
  • Phone: 865-481-0008
  • Fax: 865-481-0695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS0000004086
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: