Provider Demographics
NPI:1922379817
Name:SHARIFI, SHILA (DMD, MSC, CAGS)
Entity Type:Individual
Prefix:
First Name:SHILA
Middle Name:
Last Name:SHARIFI
Suffix:
Gender:F
Credentials:DMD, MSC, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1242
Mailing Address - Country:US
Mailing Address - Phone:978-975-8888
Mailing Address - Fax:
Practice Address - Street 1:488 ESSEX ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1242
Practice Address - Country:US
Practice Address - Phone:978-975-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN 18555391223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics