Provider Demographics
NPI:1760505754
Name:EDWARD J. PRUS, DDS, PC
Entity Type:Organization
Organization Name:EDWARD J. PRUS, DDS, PC
Other - Org Name:CENTER FOR DENTAL EXCELLENCE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-227-7787
Mailing Address - Street 1:2529 ROUTE 52
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533
Mailing Address - Country:US
Mailing Address - Phone:845-227-7787
Mailing Address - Fax:845-227-7710
Practice Address - Street 1:2529 RT 52
Practice Address - Street 2:SUITE 1
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533
Practice Address - Country:US
Practice Address - Phone:845-227-7787
Practice Address - Fax:845-227-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0298261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty