Active NPI
Alexander Colby Lusk, DDS
- Dentist
- Williamson, WV
National Provider Identifier
1891445755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4650
- Practice address
- 1628 West 3Rd Ave
Williamson, WV 25661 - Phone
- (304) 236-2366
- Fax
- (865) 305-9442
- NPI assigned
- Mar 24, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4650 | WV | Primary |
Addresses
Primary practice location
1628 West 3Rd Ave
Williamson, WV 25661
Mailing address
1628 West 3Rd Ave
Williamson, WV 25661
Phone (304) 236-2366
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220728003007 | TN | Order and Referring Only - Dentist | 5294116505 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4650 | WV | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jason R Long DDS, PLLC | Current | Accepting new patients |
Locations
1628 W 3rd Ave
Williamson, WV 25661
Phone (304) 236-2366
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Williamson, WV
- NPI 1255670063
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755734400000",
"number": "1891445755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1628 WEST 3RD AVE",
"city": "WILLIAMSON",
"state": "WV",
"postal_code": "25661",
"telephone_number": "304-236-2366",
"fax_number": "865-305-9442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1628 WEST 3RD AVE",
"city": "WILLIAMSON",
"state": "WV",
"postal_code": "25661",
"telephone_number": "304-236-2366",
"fax_number": "865-305-9442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUSK",
"first_name": "ALEXANDER",
"middle_name": "COLBY",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-24",
"last_updated": "2025-08-21",
"certification_date": "2022-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WV",
"license": "4650",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Williamson, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.