Provider Demographics
NPI:1104370402
Name:JERROLD SCHAPIRO DDS PLLC
Entity type:Organization
Organization Name:JERROLD SCHAPIRO DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-724-1324
Mailing Address - Street 1:2404 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5813
Mailing Address - Country:US
Mailing Address - Phone:315-724-1324
Mailing Address - Fax:
Practice Address - Street 1:2404 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5813
Practice Address - Country:US
Practice Address - Phone:315-724-1324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037949261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental