# SOUTH SHORE ORAL SURGERY ASSOCIATES CO. INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053462358
- **Authorized official:** DR. DAVID PAUL LUSTBADER D.M.D. (PRESIDENT)
- **Authorized official phone:** (617) 773-9500

## Contact information

- **Practice address:** 270 QUINCY AVE, QUINCY, MA 02169-8127
- **Practice address phone:** (617) 773-9500
- **Practice address fax:** (617) 773-2827
- **Mailing address:** 270 QUINCY AVE, QUINCY, MA 02169-8127
- **Mailing address phone:** (617) 773-9500
- **Mailing address fax:** (617) 773-2827

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 17663 | MA | Yes |

## Other

- **Enumeration date:** 01/15/2007
- **Last updated:** 06/30/2008