Provider Demographics
NPI:1164526315
Name:TISSURA GREGORY & SHAPIRO PC
Entity Type:Organization
Organization Name:TISSURA GREGORY & SHAPIRO PC
Other - Org Name:TGS ENDODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-256-4772
Mailing Address - Street 1:5555 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:SUITE 275
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-256-4772
Mailing Address - Fax:404-843-1743
Practice Address - Street 1:5555 PEACHTREE DUNWOODY RD
Practice Address - Street 2:SUITE 275
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-256-4772
Practice Address - Fax:404-843-1743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7927122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty