Provider Demographics
NPI:1932280831
Name:PUSCHAK, THOMAS BASIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BASIL
Last Name:PUSCHAK
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 1:175 BEDFORD STREET
Mailing Address - Street 2:SUITE 14
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420
Mailing Address - Country:US
Mailing Address - Phone:781-863-8333
Mailing Address - Fax:781-863-1210
Practice Address - Street 1:175 BEDFORD STREET
Practice Address - Street 2:SUITE 14
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420
Practice Address - Country:US
Practice Address - Phone:781-863-8333
Practice Address - Fax:781-863-1210
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice