Provider Demographics
NPI:1841622446
Name:SHAPIRO, NEIL ALAN (DMD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:ALAN
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 1:1307 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4302
Mailing Address - Country:US
Mailing Address - Phone:860-563-4058
Mailing Address - Fax:860-529-2906
Practice Address - Street 1:1307 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4302
Practice Address - Country:US
Practice Address - Phone:860-563-4058
Practice Address - Fax:860-529-2906
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008539122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist