Provider Demographics
NPI:1255484747
Name:EDWARD I SHAPIRO DDS PC
Entity Type:Organization
Organization Name:EDWARD I SHAPIRO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:IRWIN
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-661-1440
Mailing Address - Street 1:6450 FARMINGTON RD
Mailing Address - Street 2:STE. 111
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4456
Mailing Address - Country:US
Mailing Address - Phone:248-661-1440
Mailing Address - Fax:
Practice Address - Street 1:6450 FARMINGTON RD
Practice Address - Street 2:STE. 111
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4456
Practice Address - Country:US
Practice Address - Phone:248-661-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI105181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty