Provider Demographics
NPI:1740591080
Name:ALSHADWI, AHMAD ALI (BDS)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:ALI
Last Name:ALSHADWI
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 E NEWTON ST
Mailing Address - Street 2:JAMES COURT APP. #701
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4802
Mailing Address - Country:US
Mailing Address - Phone:857-445-6593
Mailing Address - Fax:
Practice Address - Street 1:850 HARRISON AVE FL ACC5
Practice Address - Street 2:BOSTON MEDICAL CENTER ORAL SURGERY DEPARTMENT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4001
Practice Address - Country:US
Practice Address - Phone:617-414-7558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL109781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery