Provider Demographics
NPI:1972667616
Name:DENTAL PLACE HOPKINTON
Entity Type:Organization
Organization Name:DENTAL PLACE HOPKINTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAB SHAMARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-435-5437
Mailing Address - Street 1:79 HAYDEN ROWE ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748
Mailing Address - Country:US
Mailing Address - Phone:508-435-5437
Mailing Address - Fax:508-435-2288
Practice Address - Street 1:79 HAYDEN ROWE ST
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748
Practice Address - Country:US
Practice Address - Phone:508-435-5437
Practice Address - Fax:508-435-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA188401223P0221X
MA164521223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty