MEDICARE: EDWARD I SHAPIRO DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	10518	MI

General Provider Information

NPI Number	:	1255484747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD I SHAPIRO DDS PC

Provider Business Mailing Address
First Line	:	6450 FARMINGTON RD
Second Line	:	STE. 111
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4456
Country	:	US
Telephone Number	:	248-661-1440
Fax Number	:

Provider Business Practice Location Address
First Line	:	6450 FARMINGTON RD
Second Line	:	STE. 111
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4456
Country	:	US
Telephone Number	:	248-661-1440
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD IRWIN SHAPIRO
Credential	:	DDS
Telephone Number	:	248-661-1440

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	08/22/2020

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