Provider Demographics
NPI:1760568539
Name:DIAB-SHAMARI, NADIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NADIA
Middle Name:
Last Name:DIAB-SHAMARI
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 1:110 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-2146
Mailing Address - Country:US
Mailing Address - Phone:617-304-2612
Mailing Address - Fax:
Practice Address - Street 1:24 LYMAN ST STE 240
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1483
Practice Address - Country:US
Practice Address - Phone:508-366-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADIX11834OtherBCBS MA
RI000X11834OtherBCBS RI