MEDICARE: DR. LARRY D SHAPIRO D.M.D.

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	1223D0001X	Public Health Dentistry	019020998	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	019020998	OTHER	IL	DENTAL LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952399917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY D SHAPIRO D.M.D.

Provider Business Mailing Address
First Line	:	8025 AUSTIN DR
Second Line	:
City	:	TROY
State	:	IL
Zip	:	62294-3612
Country	:	US
Telephone Number	:	618-667-0453
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 E CHAPIN ST
Second Line	:
City	:	LITCHFIELD
State	:	IL
Zip	:	62056-1350
Country	:	US
Telephone Number	:	217-324-3761
Fax Number	:	217-324-0313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	02/12/2013

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