Provider Demographics
NPI:1487826913
Name:CUSANELLO, DAVID ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
Last Name:CUSANELLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA182861223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics