Provider Demographics
NPI:1043263320
Name:SHAPIRO, MARINA (DDS)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 4TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4140
Mailing Address - Country:US
Mailing Address - Phone:619-294-4015
Mailing Address - Fax:619-294-4016
Practice Address - Street 1:3651 4TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4140
Practice Address - Country:US
Practice Address - Phone:619-294-4015
Practice Address - Fax:619-294-4016
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice