| Organization Name: | DR. CHARLES J. KRUSA, D.D.S. |
| NPI Number: | 1134312226 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES JOSEPH KRUSA (DENTIST) |
| Mailing Address: | 289 Highland Sq Crossville |
| State: | TN US |
| Postal Code: | 385555105 |
| Phone Number: | 9314843664 |
| Fax Number: | 9317075640 |
| NPI Enumeration Date: | 08/22/2007 |
| NPI Last Update Date: | 08/22/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | DS2393 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |