Provider Demographics
NPI:1518170125
Name:PRUSKI, CARY A (DDS)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:A
Last Name:PRUSKI
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:PO BOX 1068
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:TX
Mailing Address - Zip Code:78071
Mailing Address - Country:US
Mailing Address - Phone:361-786-2559
Mailing Address - Fax:
Practice Address - Street 1:200 THORNTON ST
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:TX
Practice Address - Zip Code:78071
Practice Address - Country:US
Practice Address - Phone:361-786-2559
Practice Address - Fax:361-786-2559
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX746006OtherCHIP