Individual
DR. DIRK GLEN PRUSIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
151 S WYMORE RD, SUITE 600, ALTAMONTE SPRINGS, FL 32714
(407) 862-8158
(407) 862-4811
Mailing address
151 S WYMORE RD, SUITE 600, ALTAMONTE SPRINGS, FL 32714
(407) 862-8158
(407) 862-4811
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10599
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60883
BLUE CROSS BLUE SHIELD
—
Enumeration date
09/01/2006
Last updated
07/08/2007
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