Nicolas Roger Pruett, DD.S.

Primary specialty

DentistTaxonomy code 122300000X

License

8913 Issued in CO

Practice address

1930 S. Nevada Ave
Colorado Springs, CO 80905-3407

Phone

(719) 576-5566

Fax

(719) 576-1100

NPI assigned

Sep 17, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Broadmoor Dental, LLC

  • General Practice Dentistry
  • Colorado Springs, CO
  • NPI 1295037646
  NPD (past) Authorized official
• Colorado Dental Professionals, LLC

  • Dentist
  • Colorado Springs, CO
  • NPI 1093456857
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281657600000",
    "number": "1215034939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 S. NEVADA AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809053407",
            "telephone_number": "719-576-5566",
            "fax_number": "719-576-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 S. NEVADA AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809053407",
            "telephone_number": "719-576-5566",
            "fax_number": "719-576-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUETT",
        "first_name": "NICOLAS",
        "middle_name": "ROGER",
        "name_prefix": "Mr.",
        "credential": "DD.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-17",
        "last_updated": "2010-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "8913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS VIRGINIA",
            "identifier": "193616",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA PROVIDER",
            "identifier": "886687",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Skylar Lynn Provencher, BT
• Zinajah Jorene Eulalie Providence- White
• Brittani Provost, MA, LPC, NCC
• Grace Provost
• Sorsche Provost
• Sylence Pruett
• J. Christopher Pruitt, M.D.
• Daniel Timothy Prutz, RN
• Areianna Rae Prybylla
• Amy Larea Pryor, PMHNP-BC

• Dentist in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.