Provider Demographics
NPI:1235518622
Name:SHAPIRO, NATHAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 PROGRESSIVE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0203
Mailing Address - Country:US
Mailing Address - Phone:757-436-1270
Mailing Address - Fax:
Practice Address - Street 1:1230 PROGRESSIVE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0203
Practice Address - Country:US
Practice Address - Phone:757-436-1270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415270122300000X
VA4014152701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentist