Healthcare Provider Details

I. General information

NPI: 1548190101
Provider Name (Legal Business Name): SHARAN DHARMESH SHAH BDS, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 FRANCIS ST
BOSTON MA
02115-6105
US

IV. Provider business mailing address

15 FRANCIS ST
BOSTON MA
02115-6105
US

V. Phone/Fax

Practice location:
  • Phone: 640-777-3398
  • Fax:
Mailing address:
  • Phone: 640-777-3398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code125Q00000X
TaxonomyOral Medicine Dentistry
License NumberDL101439
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: