Provider Demographics
NPI:1366114928
Name:PEDIATRIC DENTISTRY OF ERIE LLC
Entity type:Organization
Organization Name:PEDIATRIC DENTISTRY OF ERIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:814-868-8673
Mailing Address - Street 1:128 W 12TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1753
Mailing Address - Country:US
Mailing Address - Phone:814-868-8673
Mailing Address - Fax:814-866-0232
Practice Address - Street 1:128 W 12TH ST STE 300
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1753
Practice Address - Country:US
Practice Address - Phone:814-868-8673
Practice Address - Fax:814-866-0232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty