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General NPI Number Information
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NPI Number | 1184756496
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Entity Type | Organization
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Legal Business Name | PRUITT & EBERHART, DMD, PC
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1780 W MAIN ST
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City | CENTRE
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State | AL
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Zip | 35960-2809
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Country | US
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Telephone | 256-927-2600
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Fax | 256-927-2322
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Provider Business Mailing Address
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Address Line | 1780 W MAIN ST
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City | CENTRE
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State | AL
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Zip | 35960-2809
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Country | US
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Telephone | 256-927-2600
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Fax | 256-927-2322
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY R EBERHART
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Credential | DMD
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Telephone | 256-927-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5161
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5112
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License Number State | AL
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