Organization
THAD RUSIECKI, DDS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THAD RUSIECKI DDS (OWNER)
(304) 594-1515
Entity
Organization
Contact information
Practice address
2602 CRANBERRY SQUARE, MORGANTOWN, WV 26505
(304) 594-1515
(304) 594-0785
Mailing address
2602 CRANBERRY SQUARE, MORGANTOWN, WV 26505
(304) 594-1515
(304) 594-0785
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
3260
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000916438
MOUNTAIN STATE BCBS
WV
Enumeration date
04/17/2007
Last updated
09/15/2011
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