Mallory Gayle Pruden, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6773 Issued in LA

Practice address

135 Landreaux Dr
West Monroe, LA 71291-1509

Phone

(318) 355-8166

NPI assigned

Apr 19, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Mallory Gayle Debnam Former name

Medicare fee-for-service enrollment

Enrolled in LA

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

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.

• Nela Dental of Monroe, LLC

  • Dentist
  • Monroe, LA
  • NPI 1659788057
  NPD (past)
• Nela Sleep PLLC

  • General Practice Dentistry
  • Monroe, LA
  • NPI 1750181632
  NPD (past)

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

{
    "created_epoch": "1492560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1669906301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 LANDREAUX DR",
            "city": "WEST MONROE",
            "state": "LA",
            "postal_code": "712911509",
            "telephone_number": "318-355-8166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 LANDREAUX DR",
            "city": "WEST MONROE",
            "state": "LA",
            "postal_code": "712911509",
            "telephone_number": "318-355-8166"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2016 Tower Dr",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "LA",
            "postal_code": "712015036",
            "country_code": "US",
            "telephone_number": "318-387-5732",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7699 Highway 2",
            "address_purpose": "LOCATION",
            "city": "Farmerville",
            "state": "LA",
            "postal_code": "712416165",
            "country_code": "US",
            "telephone_number": "318-368-9518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRUDEN",
        "first_name": "MALLORY",
        "middle_name": "GAYLE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-19",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "6773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "DEBNAM",
            "middle_name": "GAYLE",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Professional Pharmacy la LLC
• Professional Pharmacy of West Monroe Louisana Inc
• Property Investors Group, LLC
• Provision Health Care LLC
• Michael M Provost, RPH
• Alexis Prudhomme
• David E. Pruett, M.D.
• Quality Home Health Inc
• Jasper Queen, LOTR
• Radiology Consultants

• General Practice Dentistry in West Monroe, LA
• Providers in West Monroe, LA by specialty
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2022; 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.