Provider Demographics
NPI:1134312226
Name:DR. CHARLES J. KRUSA, D.D.S.
Entity Type:Organization
Organization Name:DR. CHARLES J. KRUSA, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KRUSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-484-3664
Mailing Address - Street 1:289 HIGHLAND SQ
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-5105
Mailing Address - Country:US
Mailing Address - Phone:931-484-3664
Mailing Address - Fax:931-707-5640
Practice Address - Street 1:289 HIGHLAND SQ
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-5105
Practice Address - Country:US
Practice Address - Phone:931-484-3664
Practice Address - Fax:931-707-5640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS2393261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental