Provider Demographics
NPI:1205008778
Name:LEXINGTON PROSTHODONTICS
Entity Type:Organization
Organization Name:LEXINGTON PROSTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CUSANELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-862-8220
Mailing Address - Street 1:803 MASS AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-3918
Mailing Address - Country:US
Mailing Address - Phone:781-862-8220
Mailing Address - Fax:781-862-3050
Practice Address - Street 1:803 MASS AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-3918
Practice Address - Country:US
Practice Address - Phone:781-862-8220
Practice Address - Fax:781-862-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty