NPIMap

Organization Active NPI

South Shore Oral Surgery Associates Co. Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Quincy, MA
National Provider Identifier
1053462358
Registry record updated Jun 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
17663 Issued in MA
Legal business name
SOUTH SHORE ORAL SURGERY ASSOCIATES CO. INC.
Practice address
270 Quincy Ave
Quincy, MA 02169-8127
Phone
(617) 773-9500
Fax
(617) 773-2827
NPI assigned
Jan 15, 2007
Last updated
Jun 30, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David Paul Lustbader, D.M.D.NPI 1447212972
Title
President
Phone
(617) 773-9500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 17663 MA Primary

Addresses

Primary practice location

270 Quincy Ave
Quincy, MA 02169-8127

Mailing address

270 Quincy Ave
Quincy, MA 02169-8127
Phone (617) 773-9500

National Provider Directory

National Provider Directory

Locations

270 Quincy Ave
Quincy, MA 02169
Phone (617) 773-9500

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1053462358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 QUINCY AVE",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021698127",
            "telephone_number": "617-773-9500",
            "fax_number": "617-773-2827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 QUINCY AVE",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021698127",
            "telephone_number": "617-773-9500",
            "fax_number": "617-773-2827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE ORAL SURGERY ASSOCIATES CO. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-15",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "LUSTBADER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-773-9500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MA",
            "license": "17663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.