Provider Demographics
NPI:1639266257
Name:MUHAMMAD, SHAHNAZ (DMD)
Entity Type:Individual
Prefix:
First Name:SHAHNAZ
Middle Name:
Last Name:MUHAMMAD
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 1:347 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-6718
Mailing Address - Country:US
Mailing Address - Phone:781-643-7050
Mailing Address - Fax:781-643-0188
Practice Address - Street 1:347 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-6718
Practice Address - Country:US
Practice Address - Phone:781-643-7050
Practice Address - Fax:781-643-0188
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA04-3365777OtherTAX ID #
MA0277894Medicaid