# DR. JERRY PREUSS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1083700355
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | IND 1200 8025 | IN | Yes |

## Other

- **Enumeration date:** 10/05/2006
- **Last updated:** 04/02/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100231690A | — | IN |
| 01 | — | 12008025 | INDIANA LICENSE | — |
| 01 | — | 620525 | UNITED CONCORDIA | — |
| 01 | — | 805690 | BLUE CROSS BLUE SHIELD PR | IN |