Provider Demographics
NPI:1922420868
Name:SHAPIRO, ROBERT BERNARD (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BERNARD
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 1:234 77TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5720
Mailing Address - Country:US
Mailing Address - Phone:201-869-6864
Mailing Address - Fax:
Practice Address - Street 1:234 77TH ST
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5720
Practice Address - Country:US
Practice Address - Phone:201-869-6864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01048800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist