Provider Demographics
NPI:1790973873
Name:SHATHER, MERIAM IHSAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MERIAM
Middle Name:IHSAN
Last Name:SHATHER
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 1:1234 SW 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-8278
Mailing Address - Country:US
Mailing Address - Phone:954-328-4150
Mailing Address - Fax:
Practice Address - Street 1:17901 NW 5TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2810
Practice Address - Country:US
Practice Address - Phone:954-430-2188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-14
Last Update Date:2007-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN158671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice