Provider Demographics
NPI:1225562549
Name:SHAPIRO, JORDAN HARRIS (DMD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:HARRIS
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 1:17901 NW 5TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2810
Mailing Address - Country:US
Mailing Address - Phone:954-437-2222
Mailing Address - Fax:
Practice Address - Street 1:17901 NW 5TH ST STE 101
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2810
Practice Address - Country:US
Practice Address - Phone:954-437-2222
Practice Address - Fax:954-437-2244
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN265791223S0112X
MADL132931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program