Provider Demographics
NPI:1578793972
Name:SHAMSI, SAROSH A (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAROSH
Middle Name:A
Last Name:SHAMSI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 LIBRARY PARK
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1562
Mailing Address - Country:US
Mailing Address - Phone:317-881-2050
Mailing Address - Fax:317-885-7485
Practice Address - Street 1:601 LIBRARY PARK DR
Practice Address - Street 2:SUITE B-1
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1562
Practice Address - Country:US
Practice Address - Phone:317-881-2050
Practice Address - Fax:317-885-7485
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011348A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist