Healthcare Provider Details

I. General information

NPI: 1730138041
Provider Name (Legal Business Name): CRAIG S SHAPIRO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 07/31/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 MIDWAY RD SE STE 116
BOLIVIA NC
28422-8377
US

IV. Provider business mailing address

2831 MIDWAY RD SE STE 116
BOLIVIA NC
28422-8377
US

V. Phone/Fax

Practice location:
  • Phone: 910-408-4436
  • Fax:
Mailing address:
  • Phone: 910-408-4436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12565
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: