Provider Demographics
NPI:1821198532
Name:LUSTIG, DAVID P (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:LUSTIG
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 1:30567 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853-1129
Mailing Address - Country:US
Mailing Address - Phone:410-651-1498
Mailing Address - Fax:410-651-1471
Practice Address - Street 1:30567 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-1129
Practice Address - Country:US
Practice Address - Phone:410-651-1498
Practice Address - Fax:410-651-1471
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD72761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice