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NPI Code Detail

MEDICARE: DR. DAN MELBOURNE PRUCHA DDS

MEDICARE: DR. DAN MELBOURNE PRUCHA DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist20-01-4138OH
21223P0300XPeriodontics30-01-4138OH

General Provider Information

NPI Number : 1174509202
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAN MELBOURNE PRUCHA DDS
Provider Business Mailing Address
First Line : BLDG 38717, 38TH STREET
Second Line : USA DENTAC
City : FT GORDON
State : GA
Zip : 30905-5660
Country : US
Telephone Number : 706-787-6927
Fax Number : 706-787-2082
Provider Business Practice Location Address
First Line : BLDG 38717, 38TH STREET
Second Line : USA DENTAC
City : FT GORDON
State : GA
Zip : 30905-5660
Country : US
Telephone Number : 706-787-6927
Fax Number : 706-787-2082
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2005
Last Update Date : 09/11/2025

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