Provider Demographics
NPI:1952399917
Name:SHAPIRO, LARRY D (DMD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
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 1:8025 AUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-3612
Mailing Address - Country:US
Mailing Address - Phone:618-667-0453
Mailing Address - Fax:
Practice Address - Street 1:901 E CHAPIN ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-1350
Practice Address - Country:US
Practice Address - Phone:217-324-3761
Practice Address - Fax:217-324-0313
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190209981223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019020998OtherDENTAL LICENSE NUMBER
IL9179256Medicaid