Provider Demographics
NPI:1548287279
Name:ABBOTT, SHARAM SAMUEL (DMD)
Entity type:Individual
Prefix:DR
First Name:SHARAM
Middle Name:SAMUEL
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-1350
Mailing Address - Country:US
Mailing Address - Phone:978-567-8882
Mailing Address - Fax:
Practice Address - Street 1:26 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-1350
Practice Address - Country:US
Practice Address - Phone:978-567-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA179481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA17948OtherDENTAL LICENSE