Provider Demographics
NPI:1356401236
Name:AFZAAL, SHAHAB (DMD)
Entity type:Individual
Prefix:
First Name:SHAHAB
Middle Name:
Last Name:AFZAAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MIDDLESEX AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604
Mailing Address - Country:US
Mailing Address - Phone:508-756-9106
Mailing Address - Fax:
Practice Address - Street 1:463 WORCESTER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01604
Practice Address - Country:US
Practice Address - Phone:508-820-7792
Practice Address - Fax:508-872-5483
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA180691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice