Individual
MRS. STEPHANIE LYNN PRUSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DENTAL HYGIENIST
Contact information
Practice address
753 STATE AVE, KANSAS CITY, KS 66101-2516
(913) 321-4385
Mailing address
10814 W 101ST TER, OVERLAND PARK, KS 66214-2532
(913) 526-8549
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
11287
KS
124Q00000X
Dental Hygienist
2010022535
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407988710
—
KS
05
—
1841288974
—
KS
Enumeration date
08/05/2010
Last updated
08/05/2010
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