Provider Demographics
NPI:1164582193
Name:SHAPIRO, CLARA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARA
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 1:2700 W 3RD ST
Mailing Address - Street 2:SUIT# 110
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1924
Mailing Address - Country:US
Mailing Address - Phone:213-389-6969
Mailing Address - Fax:213-389-7671
Practice Address - Street 1:2700 W 3RD ST
Practice Address - Street 2:SUIT# 110
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1924
Practice Address - Country:US
Practice Address - Phone:213-389-6969
Practice Address - Fax:213-389-7671
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADG0342111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB34211-01Medicaid