Provider Demographics
NPI:1356425391
Name:SHAPIRO, MICHAEL R (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
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 1:26860 DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3531
Mailing Address - Country:US
Mailing Address - Phone:734-657-1245
Mailing Address - Fax:
Practice Address - Street 1:31620 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1819
Practice Address - Country:US
Practice Address - Phone:734-261-7800
Practice Address - Fax:734-525-7272
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010178851223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4261050Medicaid