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General NPI Number Information
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NPI Number | 1750028452
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Entity Type | Individual
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Provider Name | CHANDLER AMY LYNNE PRUITT DDS
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Gender | Female
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 100 KINGS FORT PKWY STE 100
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City | KAUFMAN
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State | TX
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Zip | 75142-3544
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Country | US
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Telephone | 469-414-0670
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Fax |
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Provider Business Mailing Address
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Address Line | 4001 MARQUETTE ST
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City | DALLAS
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State | TX
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Zip | 75225-5434
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Country | US
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Telephone | 214-729-9119
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 39261
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 39261
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License Number State | TX
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