Provider Demographics
NPI:1699029355
Name:AL-HARTHI, SHATHA SUBHI
Entity Type:Individual
Prefix:DR
First Name:SHATHA
Middle Name:SUBHI
Last Name:AL-HARTHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 WASHINGTON STREET
Mailing Address - Street 2:J ARCHSTONE BULIDING APP#23
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:646-428-4536
Mailing Address - Fax:
Practice Address - Street 1:660 WASHINGTON ST
Practice Address - Street 2:23J
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-3200
Practice Address - Country:US
Practice Address - Phone:646-428-4536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL117601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADL11760OtherLICENSE NUMBER