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General NPI Number Information
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NPI Number | 1821802000
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Entity Type | Organization
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Legal Business Name | JERALD S. PRUNER, DMD, PLLC
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 1221 MADISON ST STE 1116
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City | SEATTLE
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State | WA
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Zip | 98104-3536
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Country | US
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Telephone | 206-215-2088
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 MADISON ST STE 1116
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City | SEATTLE
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State | WA
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Zip | 98104-3536
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Country | US
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Telephone | 206-215-2088
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Fax |
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Authorized Official
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Title or Position | OWNER/ PRESIDENT
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Name | JERALD SCOTT PRUNER
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Credential | DMD
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Telephone | 206-215-2088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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