Active NPI
Jerry Preuss, DDS
- General Practice Dentistry
- Lafayette, IN
National Provider Identifier
1083700355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- IND 1200 8025
- Practice address
- 2 Walter Scholer Dr
Lafayette, IN 47909-6382 - Phone
- (765) 477-6100
- Fax
- (765) 477-5911
- NPI assigned
- Oct 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | IND 1200 8025 | IN | Primary |
Addresses
Primary practice location
2 Walter Scholer Dr
Lafayette, IN 47909-6382
Mailing address
2 Walter Scholer Dr
Lafayette, IN 47909-6382
Phone (765) 477-6100
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100231690A | Medicaid | IN | |
| 12008025 | Other | INDIANA LICENSE | |
| 620525 | Other | UNITED CONCORDIA | |
| 805690 | Other | IN | BLUE CROSS BLUE SHIELD PR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IND 1200 8025 | IN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arbor Dental LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Lafayette, IN
- NPI 1811563794
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333324800000",
"number": "1083700355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 WALTER SCHOLER DR",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479096382",
"telephone_number": "765-477-6100",
"fax_number": "765-477-5911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 WALTER SCHOLER DR",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479096382",
"telephone_number": "765-477-6100",
"fax_number": "765-477-5911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PREUSS",
"first_name": "JERRY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-05",
"last_updated": "2012-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "IND 1200 8025",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100231690A",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIANA LICENSE",
"identifier": "12008025",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "620525",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD PR",
"identifier": "805690",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.