Healthcare Provider Details

I. General information

NPI: 1972423622
Provider Name (Legal Business Name): JULIE PRUNESKI DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 COOPER FOSTER PARK RD W
LORAIN OH
44053-3731
US

IV. Provider business mailing address

690 COOPER FOSTER PARK RD W
LORAIN OH
44053-3731
US

V. Phone/Fax

Practice location:
  • Phone: 440-282-2023
  • Fax: 440-233-5401
Mailing address:
  • Phone: 440-282-2023
  • Fax: 440-233-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIE ANNE PRUNESKI DELONG
Title or Position: OWNER
Credential: DDS
Phone: 440-282-2023