Provider Demographics
NPI:1316829203
Name:PRUITT, HOLLY CHAMBERLYN (DMD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:CHAMBERLYN
Last Name:PRUITT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N FM 548 STE 105
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-5686
Mailing Address - Country:US
Mailing Address - Phone:972-552-1224
Mailing Address - Fax:
Practice Address - Street 1:101 N FM 548 STE 105
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-5686
Practice Address - Country:US
Practice Address - Phone:972-552-1224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX415531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice