Individual
DR. STANLEY A SHUSTAK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
255 PARK AVE STE 509, WORCESTER, MA 01609-1958
(508) 754-7799
(508) 754-8558
Mailing address
255 PARK AVE STE 509, WORCESTER, MA 01609-1958
(508) 754-7799
(508) 754-8558
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14677
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0042941841
UNITED CONCORDIA
MA
01
—
X04458
BLUE CROSS & BLUE SHIELD
MA
Enumeration date
01/18/2007
Last updated
07/08/2007
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