Dr. Mallory Gayle Pruden, D.D.S.
Dentist, General Practice in West Monroe, LA. Individual provider (NPI-1).
NPI number1669906301
StatusActive
Last updated in NPPESJun 13, 2022
Details
- NPI
- 1669906301
- Entity type
- Individual (NPI-1)
- Name
- Dr. Mallory Gayle Pruden
- Credential
- D.D.S.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 19, 2017
- Certification date
- Jun 13, 2022
- Last updated
- Jun 13, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · ORDER AND REFERRING ONLY - DENTIST
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 6773 | LA | Yes |
Other names
- Mallory Gayle Debnam (Former Name)
Practice location
135 Landreaux DrWest Monroe, LA 71291-1509
Phone 318-355-8166
Mailing address
135 Landreaux DrWest Monroe, LA 71291-1509
Phone 318-355-8166
Other practice locations
2016 Tower Dr
Monroe, LA 71201-5036
Monroe, LA 71201-5036
Phone 318-387-5732
7699 Highway 2
Farmerville, LA 71241-6165
Farmerville, LA 71241-6165
Phone 318-368-9518
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 19 General Practice Dentistry providers in West Monroe · All 1,219 providers in West Monroe
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