Provider Demographics
NPI:1588797740
Name:SHAKALIS, RICHARD R
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:SHAKALIS
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 1:1645 FALMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-2932
Mailing Address - Country:US
Mailing Address - Phone:508-775-9363
Mailing Address - Fax:508-862-0358
Practice Address - Street 1:1645 FALMOUTH RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-2932
Practice Address - Country:US
Practice Address - Phone:508-775-9363
Practice Address - Fax:508-862-0358
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA140281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice