Individual
GRIGORY BABADUSTOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
200 WESTGATE DRIVE, STE E135, BROCKTON, MA 02301
(508) 583-3840
Mailing address
20 EGMONT ST, APT 3, BROOKLINE, MA 02446-3614
(617) 734-4164
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
17185
MA
Other
Enumeration date
06/26/2006
Last updated
07/08/2007
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