Provider Demographics
NPI:1376281931
Name:DRUSKOVICH DENTAL PC
Entity Type:Organization
Organization Name:DRUSKOVICH DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DRUSKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-423-7866
Mailing Address - Street 1:45140 M 51
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:MI
Mailing Address - Zip Code:49045-9094
Mailing Address - Country:US
Mailing Address - Phone:269-423-7866
Mailing Address - Fax:269-423-7866
Practice Address - Street 1:45140 M 51
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:MI
Practice Address - Zip Code:49045-9094
Practice Address - Country:US
Practice Address - Phone:269-423-7866
Practice Address - Fax:269-423-7866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental