Healthcare Provider Details

I. General information

NPI: 1912237538
Provider Name (Legal Business Name): ENDODONTIC SPECIALTY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 05/14/2013
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 6454
License Number StateFL

VIII. Authorized Official

Name: DR. SETH SHAPIRO
Title or Position: MANAGING MEMBER
Credential: DDS
Phone: 305-598-6200