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General NPI Number Information
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NPI Number | 1033845078
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Entity Type | Organization
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Legal Business Name | ANDREW LUSK DDS PLLC
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Dates
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Enumeration Date | 07/30/2022
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Last Update Date | 07/30/2022
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Provider Practice Location Address
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Address Line | 46 TRIFECTA PL STE 100
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City | CHARLES TOWN
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State | WV
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Zip | 25414-5652
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Country | US
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Telephone | 304-687-8406
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Fax |
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Provider Business Mailing Address
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Address Line | 10224 REDBRIDGE RD
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-4631
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Country | US
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Telephone | 304-687-8406
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW CHRISTOPHER LUSK
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Credential | DDS
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Telephone | 304-687-8406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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