Individual
DR. JERRY PREUSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2 WALTER SCHOLER DR, LAFAYETTE, IN 47909-6382
(765) 477-6100
(765) 477-5911
Mailing address
2 WALTER SCHOLER DR, LAFAYETTE, IN 47909-6382
(765) 477-6100
(765) 477-5911
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
IND 1200 8025
IN
Other
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
Enumeration date
10/05/2006
Last updated
04/02/2012
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