Healthcare Provider Details

I. General information

NPI: 1952399917
Provider Name (Legal Business Name): LARRY D SHAPIRO D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E CHAPIN ST
LITCHFIELD IL
62056-1350
US

IV. Provider business mailing address

8025 AUSTIN DR
TROY IL
62294-3612
US

V. Phone/Fax

Practice location:
  • Phone: 217-324-3761
  • Fax: 217-324-0313
Mailing address:
  • Phone: 618-667-0453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number019020998
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: