Thaddus Rusiecki, D.D.S. PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

3260-108 Issued in WV

Practice address

2602 Cranberry Square
Morgantown, WV 26505

Phone

(304) 594-1515

Fax

(304) 594-0785

NPI assigned

Jul 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Dr. Thad Rusiecki Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• David C. Stahr, DDS, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Fairmont, WV
  • NPI 1609297068
  NPD (past)
• Greg J. Wrobleski, DDS PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Fairmont, WV
  • NPI 1194995316
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315267200000",
    "number": "1437184496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2602 CRANBERRY SQ",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265089201",
            "telephone_number": "304-594-1515",
            "fax_number": "304-594-0785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2602 CRANBERRY SQUARE",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "26505",
            "telephone_number": "304-594-1515",
            "fax_number": "304-594-0785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSIECKI",
        "first_name": "THADDUS",
        "name_prefix": "Dr.",
        "credential": "D.D.S. PLLC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2011-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WV",
            "license": "3260-108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HELATH PLAN PROVIDER NUMB",
            "identifier": "WV00411",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER NUMB",
            "identifier": "000916438",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THAD",
            "last_name": "RUSIECKI",
            "prefix": "DR.",
            "credential": "D.D.S. PLLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Braxton Runion
• Dennis Michael Ruscello, PH.D.
• Cassidy Lynn Rush
• Lindsy Brielle Rush, PA-C
• Brenda Rushman
• Russell Biundo MD Inc
• Douglas Kendal Russell, PA-C
• Jessica Russell
• Jodie L Russell, LPC
• Mary A Russell

• Oral and Maxillofacial Surgery (Dentist) in Morgantown, WV
• Providers in Morgantown, WV by specialty
• Oral and Maxillofacial Surgery (Dentist) in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2011; 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.