Provider Demographics
NPI:1427345925
Name:PRYOR, ROXANNE DENISE (DDS)
Entity type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:DENISE
Last Name:PRYOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 HAMTRAMCK DR
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48211-1400
Mailing Address - Country:US
Mailing Address - Phone:313-875-4386
Mailing Address - Fax:313-875-9160
Practice Address - Street 1:13524 GARFIELD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-4513
Practice Address - Country:US
Practice Address - Phone:313-595-7806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist