MEDICARE: DR. CORNELIUS MAURICE PRYOR III D.D.S.

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
1	122300000X	Dentist	7957	NV
2	122300000X	Dentist	35538	CA

General Provider Information

NPI Number	:	1205046281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORNELIUS MAURICE PRYOR III D.D.S.

Provider Business Mailing Address
First Line	:	4139 2ND AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-4001
Country	:	US
Telephone Number	:	323-839-8238
Fax Number	:	702-307-1305

Provider Business Practice Location Address
First Line	:	3824 COOL MEADOWS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6872
Country	:	US
Telephone Number	:	323-839-8238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	12/21/2025

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