Healthcare Provider Details

I. General information

NPI: 1356425391
Provider Name (Legal Business Name): MICHAEL R SHAPIRO D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31620 SCHOOLCRAFT RD
LIVONIA MI
48150-1819
US

IV. Provider business mailing address

26860 DRAKE RD
FARMINGTON HILLS MI
48331-3531
US

V. Phone/Fax

Practice location:
  • Phone: 734-261-7800
  • Fax: 734-525-7272
Mailing address:
  • Phone: 734-657-1245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901017885
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: