Provider Demographics
NPI:1790706356
Name:SHAPIRO, MICHAEL LEWIS
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEWIS
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-3055
Mailing Address - Country:US
Mailing Address - Phone:508-586-6002
Mailing Address - Fax:508-584-3332
Practice Address - Street 1:838 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3055
Practice Address - Country:US
Practice Address - Phone:508-586-6002
Practice Address - Fax:508-584-3332
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158861223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics