Individual
SAMUEL USTAYEV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
367 HARVARD ST, BROOKLINE, MA 02446-2938
(617) 277-1112
Mailing address
32 TRAVELER ST UNIT 212, BOSTON, MA 02118-2843
(617) 938-9161
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN1858649
MA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
10/02/2019
Last updated
10/23/2022
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