Provider Demographics
NPI:1538349642
Name:KAMACHI, SHIRO
Entity type:Individual
Prefix:DR
First Name:SHIRO
Middle Name:
Last Name:KAMACHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 W NEWTON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-6435
Mailing Address - Country:US
Mailing Address - Phone:617-266-4242
Mailing Address - Fax:617-266-7579
Practice Address - Street 1:258 W NEWTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-6435
Practice Address - Country:US
Practice Address - Phone:617-266-4242
Practice Address - Fax:617-266-7579
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204271223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics