Healthcare Provider Details

I. General information

NPI: 1386783231
Provider Name (Legal Business Name): ENDODONTIC SPECIALTY SERVICES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SW 87TH AVE SUITE A-150
MIAMI FL
33173-3570
US

IV. Provider business mailing address

7800 SW 87TH AVE SUITE A-150
MIAMI FL
33173-3570
US

V. Phone/Fax

Practice location:
  • Phone: 305-598-6200
  • Fax: 305-598-8253
Mailing address:
  • Phone: 305-598-6200
  • Fax: 305-598-8253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN 006454
License Number StateFL

VIII. Authorized Official

Name: DR. SETH JOEL SHAPIRO
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 305-598-6200