Travis Andrew Prunty, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12552 Issued in MN

Practice address

730 Madison Ave
Mankato, MN 56001-6100

Phone

(507) 388-3023

Fax

(507) 388-3353

NPI assigned

Jan 18, 2007

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484697600000",
    "number": "1275685190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 MADISON AVE",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560016100",
            "telephone_number": "507-388-3023",
            "fax_number": "507-388-3353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 MADISON AVE",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560016100",
            "telephone_number": "507-388-3023",
            "fax_number": "507-388-3353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUNTY",
        "first_name": "TRAVIS",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2017-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "12552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12552",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cailey Marie Priem, MS, ATC, ATR, CSCS
• Peyton Primmer
• Primrose Mental Health PLLC
• Progressive Living Home Care Inc.
• Progressive Living, Inc.
• Gabriela Jana Prutsky Lopez, MD
• Paula Elizabeth Prybylla, DC
• Bryan P Pucik, MD
• Mary-Joy Pugh
• Kaitlyn Ann Pumper, RN, BSN

• Dentist in Mankato, MN
• Providers in Mankato, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; 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.