Provider Demographics
NPI:1104897206
Name:PRUITT, NICOLE BATE (DMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:BATE
Last Name:PRUITT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:BATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3435 S ALAMEDA ST STE A
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1797
Mailing Address - Country:US
Mailing Address - Phone:361-992-9500
Mailing Address - Fax:
Practice Address - Street 1:3435 S ALAMEDA ST STE A
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1797
Practice Address - Country:US
Practice Address - Phone:361-992-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY74061223P0221X
TX235261223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry