Healthcare Provider Details

I. General information

NPI: 1275701013
Provider Name (Legal Business Name): PETER SHAPIRO M.S.D., P.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 25TH AVE NE #203
SEATTLE WA
98105-5667
US

IV. Provider business mailing address

4915 25TH AVE NE #203
SEATTLE WA
98105-5667
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-1999
  • Fax: 206-525-3100
Mailing address:
  • Phone: 206-525-1999
  • Fax: 206-525-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: