Prusia, Dirk Glen

Prusia, Dirk Glen is an individual health care provider with primary practice located at 151 S Wymore Rd Suite 600, Altamonte Springs FL 32714. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Prusia, Dirk Glen can be contacted via phone (407) 862-8158.

Contact Information

Primary practice address
151 S Wymore Rd Suite 600 Altamonte Springs FL 32714
Phone: (407) 862-8158
Fax: (407) 862-4811
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 10599 Florida

Profile Details

NPI number 1316049430
LBN Legal business name Prusia, Dirk Glen
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 1st, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316049430 NPPES
Other 60883 BLUE CROSS BLUE SHIELD

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