Provider Demographics
NPI:1528217783
Name:SHIKHANOVICH, ALLA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLA
Middle Name:
Last Name:SHIKHANOVICH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-1824
Mailing Address - Country:US
Mailing Address - Phone:617-331-1726
Mailing Address - Fax:
Practice Address - Street 1:315 MAIN ST STE 101315
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867
Practice Address - Country:US
Practice Address - Phone:781-944-4450
Practice Address - Fax:781-944-4451
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist