| NPI | 1053462358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID PAUL LUSTBADER President 617-773-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 17663) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2008-06-30 |