Stan Kaczkowski DDS PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

STAN KACZKOWSKI DDS PLLC

Practice address

5376 Big Tyler Rd
Cross Lanes, WV 25313-1059

Phone

(304) 776-2223

NPI assigned

Aug 13, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Stan Warren Kaczkowski, DDS

Title

Owner/Dentist

Phone

(304) 776-2223

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stanley Warren Kaczkowski, DDS

  • General Practice Dentistry
  • Cross Lanes, WV
  • NPI 1962502831
  NPD
• Amanda M Springer, DDS

  • General Practice Dentistry
  • Cross Lanes, WV
  • NPI 1689103780
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597276800000",
    "number": "1366053324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5376 BIG TYLER RD",
            "city": "CROSS LANES",
            "state": "WV",
            "postal_code": "253131059",
            "telephone_number": "304-776-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5376 BIG TYLER RD",
            "city": "CROSS LANES",
            "state": "WV",
            "postal_code": "253131059",
            "telephone_number": "304-776-2223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAN KACZKOWSKI DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-13",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A",
        "authorized_official_last_name": "KACZKOWSKI",
        "authorized_official_first_name": "STAN",
        "authorized_official_middle_name": "WARREN",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "304-776-2223",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1962502831",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0135382000",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "slegg@skaczkowskidds.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "5376 Big Tyler Rd",
            "city": "Cross Lanes",
            "state": "WV",
            "country_code": "US",
            "postal_code": "253131059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Linda Sovine
• Trisha Spangler
• Kaylisa Spaulding
• Kristina Spradling
• Amanda M Springer, DDS
• Michele Stanley, O.D.
• Alyssa Starcher, RPH
• John Everett Starcher, DDS
• Mark Kerry Stephens, MD
• Megan Stevens

• Dental Clinic/Center in Cross Lanes, WV
• Providers in Cross Lanes, WV by specialty
• Dental Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.