Provider Demographics
NPI:1528193349
Name:SHAKARCHI, MOHAMED-JAWAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED-JAWAD
Middle Name:
Last Name:SHAKARCHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HARBOR VIEW PARK
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-5822
Mailing Address - Country:US
Mailing Address - Phone:617-696-2381
Mailing Address - Fax:
Practice Address - Street 1:6C GROVE ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1534
Practice Address - Country:US
Practice Address - Phone:508-223-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice