Healthcare Provider Details

I. General information

NPI: 1497769327
Provider Name (Legal Business Name): NORBERT JAMES SHAY DMD MSCD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 E BROADWAY
SOUTH BOSTON MA
02127
US

IV. Provider business mailing address

599 E BROADWAY
SOUTH BOSTON MA
02127
US

V. Phone/Fax

Practice location:
  • Phone: 617-269-3957
  • Fax: 617-269-8254
Mailing address:
  • Phone: 617-269-3957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number11025
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: