Healthcare Provider Details

I. General information

NPI: 1669485835
Provider Name (Legal Business Name): NORBERT J SHAY DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 08/22/2020
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:
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: DR. NORBERT JAMES SHAY
Title or Position: PRESIDENT
Credential: DMD M SCD
Phone: 617-269-3957