Provider Demographics
NPI:1861800088
Name:HOSUR, SHOBHA MAHESH (DMD)
Entity type:Individual
Prefix:DR
First Name:SHOBHA
Middle Name:MAHESH
Last Name:HOSUR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 N. EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117
Mailing Address - Country:US
Mailing Address - Phone:334-801-9800
Mailing Address - Fax:334-801-9848
Practice Address - Street 1:553 N. EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117
Practice Address - Country:US
Practice Address - Phone:334-801-9800
Practice Address - Fax:334-801-9848
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1003046772Medicaid