Stanley A Shustak Jr., DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14677 Issued in MA

Practice address

255 Park Ave Ste 509
Worcester, MA 01609-1958

Phone

(508) 754-7799

Fax

(508) 754-8558

NPI assigned

Jan 18, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356494165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 PARK AVE STE 509",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091958",
            "telephone_number": "508-754-7799",
            "fax_number": "508-754-8558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 PARK AVE STE 509",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091958",
            "telephone_number": "508-754-7799",
            "fax_number": "508-754-8558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUSTAK",
        "first_name": "STANLEY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "14677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "0042941841",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "X04458",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Prateek Shukla, M.B.B.S.
• Mark Shulten
• Garrett Richard Shults, MA (INTERNSHIP)
• Shustak Dental Group, Inc.
• Michael Andrew Shustak, D.M.D.
• Judith A Shute, LICSW
• Patricia Elise Siano, NP
• Elizabeth Siaw
• Ange Florent Sibailly, RPH
• Felicite Sibailly

• General Practice Dentistry in Worcester, MA
• Providers in Worcester, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.