Provider Demographics
NPI:1790707917
Name:SHAPIRO, EDWARD I (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:I
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 1:1315 EAST BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5789
Mailing Address - Country:US
Mailing Address - Phone:704-632-9922
Mailing Address - Fax:
Practice Address - Street 1:1315 EAST BLVD STE 260
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5789
Practice Address - Country:US
Practice Address - Phone:704-632-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC62671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice