Healthcare Provider Details

I. General information

NPI: 1588653182
Provider Name (Legal Business Name): JERROLD SCHAPIRO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 GENESEE ST
UTICA NY
13502-5813
US

IV. Provider business mailing address

2404 GENESEE ST
UTICA NY
13502-5813
US

V. Phone/Fax

Practice location:
  • Phone: 315-724-1324
  • Fax: 315-735-3183
Mailing address:
  • Phone: 315-724-1324
  • Fax: 315-735-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number037949
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: