Provider Demographics
NPI:1043985146
Name:ILSHAHUOME DENTAL SURGERY
Entity type:Organization
Organization Name:ILSHAHUOME DENTAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ILSHAHUOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-371-3561
Mailing Address - Street 1:103 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02763-1015
Mailing Address - Country:US
Mailing Address - Phone:508-699-0449
Mailing Address - Fax:508-699-4344
Practice Address - Street 1:103 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:ATTLEBORO FALLS
Practice Address - State:MA
Practice Address - Zip Code:02763-1015
Practice Address - Country:US
Practice Address - Phone:508-699-0449
Practice Address - Fax:508-699-4344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental