Provider Demographics
NPI:1013059682
Name:SHAPERO, SUZANNE D (DMD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:D
Last Name:SHAPERO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5896 INVINCIBLE DR
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078
Mailing Address - Country:US
Mailing Address - Phone:315-492-7420
Mailing Address - Fax:
Practice Address - Street 1:1 CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027
Practice Address - Country:US
Practice Address - Phone:315-635-6643
Practice Address - Fax:315-635-1788
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0479311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice