Organization
STAN KACZKOWSKI DDS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STAN WARREN KACZKOWSKI DDS (OWNER/DENTIST)
(304) 776-2223
Entity
Organization
Contact information
Practice address
5376 BIG TYLER RD, CROSS LANES, WV 25313-1059
(304) 776-2223
Mailing address
5376 BIG TYLER RD, CROSS LANES, WV 25313-1059
(304) 776-2223
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0135382000
—
WV
01
—
1962502831
INDIVIDUAL NPI
—
Enumeration date
08/13/2020
Last updated
08/13/2020
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