Individual
DR. DAVID PAUL LUSTBADER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
270 QUINCY AVE, QUINCY, MA 02169-8127
(617) 773-9500
(617) 773-2827
Mailing address
270 QUINCY AVE, QUINCY, MA 02169-8127
(617) 773-9500
(617) 773-2827
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
17663
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100016
DELTA DENTAL
—
01
—
X06287
BCBS
—
Enumeration date
04/03/2006
Last updated
07/08/2007
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