Provider Demographics
NPI:1962121699
Name:SOHA SHAMAS DDS PC
Entity type:Organization
Organization Name:SOHA SHAMAS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-853-6638
Mailing Address - Street 1:23601 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1227
Mailing Address - Country:US
Mailing Address - Phone:313-565-8544
Mailing Address - Fax:313-565-3870
Practice Address - Street 1:23601 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1227
Practice Address - Country:US
Practice Address - Phone:313-565-8544
Practice Address - Fax:313-565-3870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental