Provider Demographics
NPI:1497769327
Name:SHAY, NORBERT JAMES (DMD MSCD)
Entity type:Individual
Prefix:DR
First Name:NORBERT
Middle Name:JAMES
Last Name:SHAY
Suffix:
Gender:M
Credentials:DMD MSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127
Mailing Address - Country:US
Mailing Address - Phone:617-269-3957
Mailing Address - Fax:
Practice Address - Street 1:599 E BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127
Practice Address - Country:US
Practice Address - Phone:617-269-3957
Practice Address - Fax:617-269-8254
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0234117Medicaid
MA9715738Medicaid