Provider Demographics
NPI:1609352905
Name:SHAPIRO FAMILY DENTISTRY OF FORT PIERCE PA
Entity Type:Organization
Organization Name:SHAPIRO FAMILY DENTISTRY OF FORT PIERCE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-254-2868
Mailing Address - Street 1:2247 PALM BEACH LAKES BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3408
Mailing Address - Country:US
Mailing Address - Phone:561-254-2868
Mailing Address - Fax:561-328-6217
Practice Address - Street 1:CORAL SQUARE SHOPPES 3006 US HIGHWAY 1
Practice Address - Street 2:SUITE D2/D3
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982
Practice Address - Country:US
Practice Address - Phone:772-242-0053
Practice Address - Fax:772-242-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010511900Medicaid