Provider Demographics
NPI:1922122407
Name:SHUSTER, JEFFREY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:SHUSTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SHUNPIKE RD STE 7
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2454
Mailing Address - Country:US
Mailing Address - Phone:860-635-3993
Mailing Address - Fax:860-635-9088
Practice Address - Street 1:28 SHUNPIKE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2454
Practice Address - Country:US
Practice Address - Phone:860-635-3993
Practice Address - Fax:860-635-9088
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice