Provider Demographics
NPI:1568985851
Name:LUKASIEWICZ AND BELLAVANCE LLC
Entity Type:Organization
Organization Name:LUKASIEWICZ AND BELLAVANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LUKASIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-932-5999
Mailing Address - Street 1:3 BALDWIN GREEN CMN STE 101
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1866
Mailing Address - Country:US
Mailing Address - Phone:781-932-5999
Mailing Address - Fax:
Practice Address - Street 1:3 BALDWIN GREEN COMMON SUITE 101
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801
Practice Address - Country:US
Practice Address - Phone:781-932-5999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN191651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty