Thad Rusiecki, DDS, PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

3260 Issued in WV

Legal business name

THAD RUSIECKI, DDS, PLLC

Practice address

2602 Cranberry Square
Morgantown, WV 26505

Phone

(304) 594-1515

Fax

(304) 594-0785

NPI assigned

Apr 17, 2007

Organization subpart

No

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

Authorized official

Name

Thad Rusiecki, DDS

Title

Owner

Phone

(304) 594-1515

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316044800000",
    "number": "1992921092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": {
        "organization_name": "THAD RUSIECKI, DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2011-09-15",
        "status": "A",
        "authorized_official_last_name": "RUSIECKI",
        "authorized_official_first_name": "THAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-594-1515",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WV",
            "license": "3260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOUNTAIN STATE BCBS",
            "identifier": "000916438",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Enrique Teran, MD
• Teresa L. White
• Kylie Teter
• Stellman Teter Jr., MSN, RN, ACNPAG-C
• Maryam Tetlay, MD
• Shyam J. Thakkar, M.D.
• Vishal Vishnu Thakur
• Satid Thammasitboon, M.D.
• Sittinun Thangjui
• Amy Thaxton

• 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 15, 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.