Provider Demographics
NPI:1003089228
Name:THAFUR SHEMMERI, DMD,MSCD,DSCD,PC
Entity Type:Organization
Organization Name:THAFUR SHEMMERI, DMD,MSCD,DSCD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THAFUR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEMMERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-342-3004
Mailing Address - Street 1:100 WHALON ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420
Mailing Address - Country:US
Mailing Address - Phone:978-342-3004
Mailing Address - Fax:978-343-7959
Practice Address - Street 1:100 WHALON ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420
Practice Address - Country:US
Practice Address - Phone:978-342-3004
Practice Address - Fax:978-343-7959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0215261Medicaid