Provider Demographics
NPI:1659663094
Name:LUKASIEWICZ, JOSEPH PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PAUL
Last Name:LUKASIEWICZ
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 1:3 BALDWIN GREEN CMN
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1865
Mailing Address - Country:US
Mailing Address - Phone:781-932-5999
Mailing Address - Fax:781-935-4804
Practice Address - Street 1:3 BALDWIN GREEN CMN
Practice Address - Street 2:SUITE #101
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1865
Practice Address - Country:US
Practice Address - Phone:781-932-5999
Practice Address - Fax:781-935-4804
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA191651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice