Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DL13949 | MA |
NPI | 1336707462 |
---|---|
Provider Name | Adam O Shafik |
First Address | Boston, MA 02114-2750 |
Second Address | Boston, MA 02114-2750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2019 |
Last Update Date | 04/06/2019 |