Provider Demographics
NPI:1003706839
Name:HALLETT, SHAWN ALEXANDER (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ALEXANDER
Last Name:HALLETT
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 SHIP AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-7207
Mailing Address - Country:US
Mailing Address - Phone:781-243-1222
Mailing Address - Fax:
Practice Address - Street 1:968 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3989
Practice Address - Country:US
Practice Address - Phone:781-549-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program