Provider Demographics
NPI:1730138041
Name:SHAPIRO, CRAIG S (DMD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:S
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 MIDWAY RD SE STE 116
Mailing Address - Street 2:
Mailing Address - City:BOLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28422-8377
Mailing Address - Country:US
Mailing Address - Phone:910-408-4436
Mailing Address - Fax:
Practice Address - Street 1:2831 MIDWAY RD SE STE 116
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-8377
Practice Address - Country:US
Practice Address - Phone:910-408-4436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC125651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01751308Medicaid