| NPI | 1992921092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THAD RUSIECKI Owner 304-594-1515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WV 3260) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2011-09-15 |