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Stan Kaczkowski Dds Pllc
Dental Clinic/Center in Cross Lanes, West Virginia
NPI 1366053324

Stan Kaczkowski Dds Pllc is a Dental Clinic/Center based in Cross Lanes, WV and is specialized in Dental. Stan Kaczkowski Dds Pllc practices in Cross Lanes, WV. The NPI Number for Stan Kaczkowski Dds Pllc is 1366053324 and holds a License No. (West Virginia).

The current practice location address for Stan Kaczkowski Dds Pllc is 5376 Big Tyler Rd, Cross Lanes, WV and can be reached out via phone at 304-776-2223.

Location: 5376 Big Tyler Rd, Cross Lanes, WV, 25313-1059
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1366053324
Provider Name
Stan Kaczkowski Dds Pllc
Credential
Provider Entity Type
Organization
Address
5376 Big Tyler Rd, Cross Lanes, WV, 25313-1059
Phone Number
304-776-2223
Fax Number
Provider Enumeration Date
08/13/2020
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1962502831 01 INDIVIDUAL NPI
0135382000 05 WV
institution
Provider Business Practice Location Address Details
Address
5376 Big Tyler Rd
City
Cross Lanes
State
West Virginia
Zip
25313-1059
Phone Number
304-776-2223
Fax Number
person
Provider Business Mailing Address Details
Address
5376 Big Tyler Rd
City
Cross Lanes
State
West Virginia
Zip
25313-1059
Phone Number
304-776-2223
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Dental
Taxonomy
261QD0000X
License No.
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Definition
Definition to come...
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