Provider Demographics
NPI:1356758858
Name:DACHER-SHAPIRO, JUDSON (DMD)
Entity type:Individual
Prefix:
First Name:JUDSON
Middle Name:
Last Name:DACHER-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:NAVAL HEALTH CLINIC NEW ENGLAND
Mailing Address - Street 2:43 SMITH ROAD
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02842
Mailing Address - Country:US
Mailing Address - Phone:401-841-1873
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HEALTH CLINIC NEW ENGLAND
Practice Address - Street 2:43 SMITH ROAD
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02842
Practice Address - Country:US
Practice Address - Phone:401-841-1873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014178811223S0112X
RIDEN034751223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery