Michael Andrew Shustak, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

20643 Issued in MA

Practice address

255 Park Ave
Suite 509
Worcester, MA 01609-1953

Phone

(508) 754-7799

NPI assigned

Aug 2, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in MA

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

• Shustak Dental Group, Inc.

  • Dentist
  • Worcester, MA
  • NPI 1417079906
  Authorized official Same address or phone

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821005562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 LEXINGTON RD",
            "city": "SHREWSBURY",
            "state": "MA",
            "postal_code": "015452267",
            "telephone_number": "508-754-7799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 PARK AVE",
            "address_2": "SUITE 509",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091953",
            "telephone_number": "508-754-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUSTAK",
        "first_name": "MICHAEL",
        "middle_name": "ANDREW",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "20643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Manjul Shukla, MD
• Prateek Shukla, M.B.B.S.
• Mark Shulten
• Garrett Richard Shults, MA (INTERNSHIP)
• Shustak Dental Group, Inc.
• Stanley A Shustak Jr., DDS
• Judith A Shute, LICSW
• Patricia Elise Siano, NP
• Elizabeth Siaw
• Ange Florent Sibailly, RPH

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.