| Thad Rusiecki, Dds, Pllc | |
|
2602 Cranberry Square Morgantown WV 26505 | |
| (304) 594-1515 | |
| (304) 594-0785 |
| Full Name | Thad Rusiecki, Dds, Pllc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 2602 Cranberry Square, Morgantown, West Virginia |
| Authorized Official Name and Position | Thad Rusiecki (OWNER) |
| Authorized Official Contact | 3045941515 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thad Rusiecki, Dds, Pllc 2602 Cranberry Square Morgantown WV 26505 Ph: (304) 594-1515 | Thad Rusiecki, Dds, Pllc 2602 Cranberry Square Morgantown WV 26505 Ph: (304) 594-1515 |
| NPI Number | 1992921092 |
|---|---|
| Provider Enumeration Date | 04/17/2007 |
| Last Update Date | 09/15/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992921092 | NPI | - | NPPES |
| 000916438 | Other | WV | MOUNTAIN STATE BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 3260 (West Virginia) | Primary |
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