William Bailey Pruden III, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

2901020828 Issued in MI

Practice address

628 Progress St Ste 200
West Branch, MI 48661-9383

Phone

(989) 343-1496

Fax

(989) 343-1498

NPI assigned

Apr 2, 2007

Last updated

Dec 8, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1215058185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3434 M 119",
            "address_2": "STE H",
            "city": "HARBOR SPRINGS",
            "state": "MI",
            "postal_code": "497409373",
            "telephone_number": "231-251-9083",
            "fax_number": "231-308-5941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "628 PROGRESS ST STE 200",
            "city": "WEST BRANCH",
            "state": "MI",
            "postal_code": "486619383",
            "telephone_number": "989-343-1496",
            "fax_number": "989-343-1498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUDEN",
        "first_name": "WILLIAM",
        "middle_name": "BAILEY",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401008656",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901020828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7708",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jessica Quigley
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• Savanna Ann Rabidue, RN
• Seshma Ramsawak, MD
• Tyler James Ranger, BAA

• Dentist in West Branch, MI
• Providers in West Branch, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.