Basic Information
Provider Information
NPI: 1811409238
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALSHEHRI
FirstName: ABDULLAH
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 E NEWTON ST
Address2:  
City: BOSTON
State: MA
PostalCode: 021182308
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 100 E NEWTON ST
Address2:  
City: BOSTON
State: MA
PostalCode: 021182308
CountryCode: US
TelephoneNumber: 6176384750
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/25/2017
LastUpdateDate: 10/25/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223P0300XDL13461MAY Dental ProvidersDentistPeriodontics

No ID Information.


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