David Paul Lustbader, D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

17663 Issued in MA

Practice address

270 Quincy Ave
Quincy, MA 02169-8127

Phone

(617) 773-9500

Fax

(617) 773-2827

NPI assigned

Apr 3, 2006

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2020 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• South Shore Oral Surgery Associates Co. Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Quincy, MA
  • NPI 1053462358

  Oral and Maxillofacial Surgery

  NPD (past) Authorized official
• 42 North Dental Oral Surgery of Ma, PLLC

  • Dental Clinic/Center
  • Quincy, MA
  • NPI 1730846403
  NPD (past)

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1447212972",
    "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": {
        "last_name": "LUSTBADER",
        "first_name": "DAVID",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-03",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MA",
            "license": "17663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "X06287",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "100016",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lumiere Dental Spa, LLC
• Lily Luo
• Xuan Luo
• My Phu Luong
• Andrew Luque
• Michelle Luster
• Talitha Anne Lutes, LMHC
• Viktoriya Lutsiv, PHARMD
• Lux Dental
• Luxe Path Behavioral Health & Wellness PLLC

• All providers in Quincy, MA
• Oral and Maxillofacial Surgery (Dentist) in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.