Provider Demographics
NPI:1316475304
Name:SHALASH, AL-HARITH M (DMD)
Entity type:Individual
Prefix:
First Name:AL-HARITH
Middle Name:M
Last Name:SHALASH
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 1:2358 NICHOLASVILLE RD STE 156
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3041
Mailing Address - Country:US
Mailing Address - Phone:859-381-0680
Mailing Address - Fax:
Practice Address - Street 1:2358 NICHOLASVILLE RD STE 156
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3041
Practice Address - Country:US
Practice Address - Phone:859-381-0680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY99551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice