Provider Demographics
NPI:1528413275
Name:SHABANI, QUENTIN
Entity Type:Individual
Prefix:
First Name:QUENTIN
Middle Name:
Last Name:SHABANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LONGFELLOW PL
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2438
Mailing Address - Country:US
Mailing Address - Phone:617-416-6154
Mailing Address - Fax:
Practice Address - Street 1:1 LONGFELLOW PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2438
Practice Address - Country:US
Practice Address - Phone:617-416-6154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18578151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice