Provider Demographics
NPI:1467246801
Name:PROUSI, ANDREW STEPHEN (DMD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:STEPHEN
Last Name:PROUSI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 LEVERING ST
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1874
Mailing Address - Country:US
Mailing Address - Phone:215-470-8662
Mailing Address - Fax:
Practice Address - Street 1:658 LEVERING ST
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1874
Practice Address - Country:US
Practice Address - Phone:215-470-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019691L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice