Provider Demographics
NPI:1992934830
Name:PROUSI, ANTHONY (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:PROUSI
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MOUNT HOLLY ROAD, BLDG 500
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016
Mailing Address - Country:US
Mailing Address - Phone:609-526-8650
Mailing Address - Fax:609-526-8640
Practice Address - Street 1:1900 MOUNT HOLLY ROAD, BLDG 500
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016
Practice Address - Country:US
Practice Address - Phone:609-526-8650
Practice Address - Fax:609-526-8640
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI02541600122300000X
PADS0373341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist