Provider Demographics
NPI:1750682258
Name:HASHEMI, SHAHAB (DMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHAHAB
Middle Name:
Last Name:HASHEMI
Suffix:
Gender:M
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-5039
Mailing Address - Country:US
Mailing Address - Phone:610-876-9143
Mailing Address - Fax:
Practice Address - Street 1:2400 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-5039
Practice Address - Country:US
Practice Address - Phone:610-876-9143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026725L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice