Provider Demographics
NPI:1598179533
Name:SHAPIRO, KYLE P (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:P
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8430 PERSHALL RD
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-3075
Mailing Address - Country:US
Mailing Address - Phone:314-521-5678
Mailing Address - Fax:
Practice Address - Street 1:8430 PERSHALL RD
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-3075
Practice Address - Country:US
Practice Address - Phone:314-521-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014016849122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist