Provider Demographics
NPI:1932528866
Name:SHEHADEH, BASHAR A (DMD)
Entity Type:Individual
Prefix:
First Name:BASHAR
Middle Name:A
Last Name:SHEHADEH
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 1:10 AUDUBON LN
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:RI
Mailing Address - Zip Code:02831-1627
Mailing Address - Country:US
Mailing Address - Phone:401-573-5503
Mailing Address - Fax:
Practice Address - Street 1:121 SANDY BOTTOM RD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-5865
Practice Address - Country:US
Practice Address - Phone:401-822-3352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN032121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice