Healthcare Provider Details

I. General information

NPI: 1912340019
Provider Name (Legal Business Name): ERIC ZANE SHAPIRA D.D.S., M.A., M.H.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 UNION ST
SAN FRANCISCO CA
94123-3900
US

IV. Provider business mailing address

PO BOX 535
RAMONA CA
92065-0535
US

V. Phone/Fax

Practice location:
  • Phone: 415-922-3886
  • Fax: 415-922-3883
Mailing address:
  • Phone: 650-619-1251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: