Provider Demographics
NPI:1710153929
Name:SHREM, MAURICE (NONE) (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:(NONE)
Last Name:SHREM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1920
Mailing Address - Country:US
Mailing Address - Phone:718-375-6402
Mailing Address - Fax:718-375-6496
Practice Address - Street 1:1720 E 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1920
Practice Address - Country:US
Practice Address - Phone:718-375-6402
Practice Address - Fax:718-375-6496
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0304901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice