Provider Demographics
NPI:1033845078
Name:ANDREW LUSK DDS PLLC
Entity Type:Organization
Organization Name:ANDREW LUSK DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:LUSK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-687-8406
Mailing Address - Street 1:10224 REDBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4631
Mailing Address - Country:US
Mailing Address - Phone:304-687-8406
Mailing Address - Fax:
Practice Address - Street 1:46 TRIFECTA PL STE 100
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-5652
Practice Address - Country:US
Practice Address - Phone:304-687-8406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty