Provider Demographics
NPI:1023011780
Name:SHAPIRO, BERNARD DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:DAVID
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 1:97 EAGLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111
Mailing Address - Country:US
Mailing Address - Phone:860-563-4058
Mailing Address - Fax:860-529-2906
Practice Address - Street 1:1307 SILAS DEANE HIGHWAY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109
Practice Address - Country:US
Practice Address - Phone:860-563-4058
Practice Address - Fax:860-529-2906
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT42321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT460468966OtherTAX ID