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General NPI Number Information
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NPI Number | 1619360583
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Entity Type | Organization
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Legal Business Name | BEACON SQUARE FAMILY DENTISTRY PA
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7805 NW BEACON SQUARE BLVD STE 101
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City | BOCA RATON
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State | FL
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Zip | 33487-1396
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Country | US
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Telephone | 561-998-0901
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Fax | 561-998-0903
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Provider Business Mailing Address
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Address Line | 7805 NW BEACON SQUARE BLVD STE 101
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City | BOCA RATON
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State | FL
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Zip | 33487-1396
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Country | US
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Telephone | 561-998-0901
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Fax | 561-998-0903
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DARI SHAPIRO
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Credential | DDS
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Telephone | 561-254-2868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 15490
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN15490
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License Number State | FL
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