Basic Information
| Provider Information | |||||||||
| NPI: | 1568985851 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LUKASIEWICZ AND BELLAVANCE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 BALDWIN GREEN CMN STE 101 | ||||||||
| Address2: | |||||||||
| City: | WOBURN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018011866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819325999 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3 BALDWIN GREEN COMMON SUITE 101 | ||||||||
| Address2: | |||||||||
| City: | WOBURN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819325999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | LUKASIEWICZ | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | PAUL | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7819325999 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DMD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DN19165 | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.