Provider Demographics
NPI:1073522702
Name:PRUSKI, SHELLI RICHTER (DDS)
Entity Type:Individual
Prefix:
First Name:SHELLI
Middle Name:RICHTER
Last Name:PRUSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:POTH
Mailing Address - State:TX
Mailing Address - Zip Code:78147-0930
Mailing Address - Country:US
Mailing Address - Phone:830-484-1259
Mailing Address - Fax:
Practice Address - Street 1:800 N BRYANT ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-2550
Practice Address - Country:US
Practice Address - Phone:830-569-2500
Practice Address - Fax:830-281-6436
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice