Active NPI
Dirk Glen Prusia, DDS
- General Practice Dentistry
- Altamonte Springs, FL
National Provider Identifier
1316049430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10599
- Practice address
- 151 S Wymore Rd
Suite 600
Altamonte Springs, FL 32714 - Phone
- (407) 862-8158
- Fax
- (407) 862-4811
- NPI assigned
- Sep 1, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 10599 | FL | Primary |
Addresses
Primary practice location
151 S Wymore Rd
Suite 600
Altamonte Springs, FL 32714
Mailing address
151 S Wymore Rd
Suite 600
Altamonte Springs, FL 32714
Phone (407) 862-8158
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60883 | Other | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150604001220 | FL | Order and Referring Only - Dentist | 6709107550 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10599 | FL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316049430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "151 S WYMORE RD",
"address_2": "SUITE 600",
"city": "ALTAMONTE SPRINGS",
"state": "FL",
"postal_code": "32714",
"telephone_number": "407-862-8158",
"fax_number": "407-862-4811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 S WYMORE RD",
"address_2": "SUITE 600",
"city": "ALTAMONTE SPRINGS",
"state": "FL",
"postal_code": "32714",
"telephone_number": "407-862-8158",
"fax_number": "407-862-4811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUSIA",
"first_name": "DIRK",
"middle_name": "GLEN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "10599",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "60883",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Altamonte Springs, FL
- Primehealth Family Practice LLC
- Primera Choice Walk in Clinic of Altamonte
- Primerica
- Paige Leigh Prince, ATC, LAT
- Emma Proctor, BS, BCABA
- Psychiatric Innovators of Greater Orlando Inc
- Psychological Wellness for Children & Families, Inc
- Carol French Publicover, ARNP
- Publix Super Markets Inc
- Publix Super Markets Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.