Provider Demographics
NPI:1295230225
Name:SHAPIRO, JONATHAN HARRY (DMD, MDSC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:HARRY
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:DMD, MDSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-7001
Mailing Address - Country:US
Mailing Address - Phone:310-702-3970
Mailing Address - Fax:
Practice Address - Street 1:2901 WILSHIRE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4905
Practice Address - Country:US
Practice Address - Phone:310-564-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1039871223G0001X, 1223E0200X
390200000X
CT13402390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program