Provider Demographics
NPI:1629118294
Name:SHAPIRO, NATHAN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:J
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 1:5500 TELEGRAPH RD
Mailing Address - Street 2:201
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4250
Mailing Address - Country:US
Mailing Address - Phone:805-644-5619
Mailing Address - Fax:805-644-4841
Practice Address - Street 1:5500 TELEGRAPH RD
Practice Address - Street 2:201
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4250
Practice Address - Country:US
Practice Address - Phone:805-644-5619
Practice Address - Fax:805-644-4841
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics