| Stan Kaczkowski Dds Pllc | |
|
5376 Big Tyler Rd Cross Lanes WV 25313-1059 | |
| (304) 776-2223 | |
| Not Available |
| Full Name | Stan Kaczkowski Dds Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 5376 Big Tyler Rd, Cross Lanes, West Virginia |
| Authorized Official Name and Position | Stan Warren Kaczkowski (OWNER/DENTIST) |
| Authorized Official Contact | 3047762223 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stan Kaczkowski Dds Pllc 5376 Big Tyler Rd Cross Lanes WV 25313-1059 Ph: (304) 776-2223 | Stan Kaczkowski Dds Pllc 5376 Big Tyler Rd Cross Lanes WV 25313-1059 Ph: (304) 776-2223 |
| NPI Number | 1366053324 |
|---|---|
| Provider Enumeration Date | 08/13/2020 |
| Last Update Date | 08/13/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366053324 | NPI | - | NPPES |
| 1962502831 | Other | INDIVIDUAL NPI | |
| 0135382000 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Mitri A. Ghareeb, Dds, Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 5480 Big Tyler Road, Suite 1, Cross Lanes, WV 25313 Phone: 304-776-1212 Fax: 304-776-4542 | |
Ghareeb & Ghareeb Dds, Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 814 Cross Lanes Dr, Cross Lanes, WV 25313 Phone: 304-776-4541 Fax: 304-776-4542 | |
Amanda Springer Dds Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 5376 Big Tyler Rd, Cross Lanes, WV 25313 Phone: 304-776-2223 Fax: 304-776-2223 |