Provider Demographics
NPI:1447403688
Name:PRUSA, LOU (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOU
Middle Name:
Last Name:PRUSA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10251 TORRE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2186
Mailing Address - Country:US
Mailing Address - Phone:408-252-7274
Mailing Address - Fax:408-252-7297
Practice Address - Street 1:10251 TORRE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2186
Practice Address - Country:US
Practice Address - Phone:408-252-7274
Practice Address - Fax:408-252-7297
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice