Healthcare Provider Details

I. General information

NPI: 1992934830
Provider Name (Legal Business Name): ANTHONY PROUSI DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MOUNT HOLLY ROAD, BLDG 500
BURLINGTON NJ
08016
US

IV. Provider business mailing address

1900 MOUNT HOLLY ROAD, BLDG 500
BURLINGTON NJ
08016
US

V. Phone/Fax

Practice location:
  • Phone: 609-526-8650
  • Fax: 609-526-8640
Mailing address:
  • Phone: 609-526-8650
  • Fax: 609-526-8640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDI02541600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS037334
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: