Organization
BAY STATE ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, P.C.
Active
Other names
John M Ristuccia, DDS and Associates, PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN MICHAEL RISTUCCIA D.D.S. (PRESIDENT)
(978) 686-4187
Entity
Organization
Contact information
Practice address
100 AMESBURY ST, SUITE 112, LAWRENCE, MA 01840-1321
(978) 686-4187
(978) 686-0941
Mailing address
100 AMESBURY ST, SUITE 112, LAWRENCE, MA 01840-1321
(978) 686-4187
(978) 686-0941
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
11590
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024745
CIGNA HEALTHCARE
MA
01
—
585304
UNITED CONCORDIA
MA
01
—
600593
TUFTS HEALTH PLAN
MA
01
—
689643
TUFTS HEALTH PLAN
MA
01
—
M11729
BLUE CROSS BLUE SHIELD
MA
01
—
X10821
BLUE CROSS BLUE SHIELD
MA
Enumeration date
12/23/2006
Last updated
08/22/2020
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