Provider Demographics
NPI:1275701013
Name:SHAPIRO, PETER (MSD, PS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MSD, PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 25TH AVE NE
Mailing Address - Street 2:#203
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5667
Mailing Address - Country:US
Mailing Address - Phone:206-525-1999
Mailing Address - Fax:206-525-3100
Practice Address - Street 1:4915 25TH AVE NE
Practice Address - Street 2:#203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5667
Practice Address - Country:US
Practice Address - Phone:206-525-1999
Practice Address - Fax:206-525-3100
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics