Provider Demographics
NPI:1770220543
Name:ALGHAMDI, SHADI MOHAMMED (BDS)
Entity Type:Individual
Prefix:MR
First Name:SHADI
Middle Name:MOHAMMED
Last Name:ALGHAMDI
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 KNEELAND ST
Mailing Address - Street 2:TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-636-6828
Mailing Address - Fax:617-636-6809
Practice Address - Street 1:1 KNEELAND ST
Practice Address - Street 2:TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-6828
Practice Address - Fax:617-636-6809
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program