Provider Demographics
NPI:1316055817
Name:SHARE, JACK BENNET (DDS)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:BENNET
Last Name:SHARE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109
Mailing Address - Country:US
Mailing Address - Phone:617-742-1350
Mailing Address - Fax:617-244-1024
Practice Address - Street 1:31 STATE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-2705
Practice Address - Country:US
Practice Address - Phone:617-742-1350
Practice Address - Fax:617-244-1024
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist