Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1295045797 Deactivated / Inactive NPI Male Practitioner

Dr. Brandon Rogers Prusa , DDS

Dentist • Chicago, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Brandon Prusa has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date October 18, 2010
NPI Deactivation Date July 03, 2025
Total Practice Duration ~15 Years of Practice (2010 – 2025)

Professional Overview & Biography Verified Profile Summary

Dr. Brandon Prusa, DDS was a registered Dentist practicing in Chicago, IL. Throughout an active medical career spanning 15 years, Dr. Prusa provided care at the practice location at 4516 S DAMEN AVE until profile deactivation on 2025-07-03.

Practice Location & Contact Primary Location

Practice Address

4516 S Damen Ave

Chicago, IL 606093013

Telephone 7738690200
Associated Practice Facility / Clinic
🏢 Studio Dental, Llc Facility NPI 1629249610

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist in Chicago, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 16.1 Yrs
State Avg: 12.1 Yrs
Regional Practice Density
1207 Specialists

Practicing in Chicago, IL (4751 Statewide)

Telehealth Adoption Rate
0.1% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist Primary Specialty

NUCC Taxonomy Code: 122300000X

State License IL 019028511

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

8 Associated Practitioners
NPI 1003266958

Doctor of Dental Surgery

NPI 1003354911
NPI 1487967238

Doctor of Dental Surgery

Shahneel Ahmed , BDS, MS, OFP (CERT)

Dentist - General Practice

NPI 1508546151

BDS, Master of Science, OFP(CERT)

Dr. David Choi , DDS

Dentist - General Practice

NPI 1518228667

Doctor of Dental Surgery

NPI 1528264090

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated July 03, 2025

Record deactivated on July 03, 2025

NPI Profile Active October 18, 2010

NPI status registered as active in NPPES database

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Updated Practice Location October 18, 2010

Registered at 4516 S DAMEN AVE, CHICAGO, IL 606093013 (Tel: 7738690200)

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Updated Business Mailing Address October 18, 2010

Registered at 2348 N LISTER AVE, APT 407, CHICAGO, IL 606142994 (Tel: 7859795147)

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Provider Name / Credentials Updated October 18, 2010

Recorded as BRANDON PRUSA, DDS

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Medical Taxonomy / Specialty Registered (Primary Specialty) October 18, 2010

Dentist (License #019028511 in IL)

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Initial NPI Registration & Enumeration October 18, 2010

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1295045797
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: October 18, 2010
Last Update: October 18, 2010
Deactivation Date: July 03, 2025

Mailing Address

2348 N Lister Ave, Apt 407

Chicago, IL 606142994

Phone: 7859795147

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.