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NPI Code Detail

MEDICARE: DR. DMITRIY SHPAK DDS

MEDICARE: DR. DMITRIY SHPAK DDS
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
11223G0001XGeneral Practice Dentistry2020024031MO
21223G0001XGeneral Practice Dentistry7126LA

General Provider Information

NPI Number : 1922617752
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DMITRIY SHPAK DDS
Provider Business Mailing Address
First Line : 14666 W MAIN ST
Second Line :
City : CUT OFF
State : LA
Zip : 70345-3208
Country : US
Telephone Number : 985-632-6188
Fax Number :
Provider Business Practice Location Address
First Line : 14666 W MAIN ST
Second Line :
City : CUT OFF
State : LA
Zip : 70345-3208
Country : US
Telephone Number : 985-632-6188
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2020
Last Update Date : 02/21/2025

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Directions to “ DR. DMITRIY SHPAK DDS” Practice Location

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