Provider Demographics
NPI:1003346362
Name:SHAPIRO, BENJAMIN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:E
Last Name:SHAPIRO
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 1:4051 POSTAL DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6439
Mailing Address - Country:US
Mailing Address - Phone:540-774-0061
Mailing Address - Fax:
Practice Address - Street 1:4051 POSTAL DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6439
Practice Address - Country:US
Practice Address - Phone:540-774-0061
Practice Address - Fax:540-330-5311
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014156771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice