Provider Demographics
NPI:1285809798
Name:CUSP DENTAL LABORATORY
Entity type:Organization
Organization Name:CUSP DENTAL LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMIYO
Authorized Official - Middle Name:W
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-388-0078
Mailing Address - Street 1:381 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-6606
Mailing Address - Country:US
Mailing Address - Phone:781-388-0078
Mailing Address - Fax:
Practice Address - Street 1:381 PEARL ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-6606
Practice Address - Country:US
Practice Address - Phone:781-388-0078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory