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Organization
PACIFIC HOLISTIC DENTAL, INC.
Active
Organization
PACIFIC HOLISTIC DENTAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD SHAPIRO D.D.S (OWNER/ OPERATOR)
(805) 929-6814
Entity
Organization
Contact information
Practice address
530 W TEFFT ST, NIPOMO, CA 93444-8946
(805) 929-6814
(805) 929-2047
Mailing address
530 W TEFFT ST, NIPOMO, CA 93444-8946
(805) 929-6814
(805) 929-2047
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
57466
CA
1223E0200X
Endodontics
57466
CA
1223G0001X
General Practice Dentistry
57466
CA
1223P0106X
Oral and Maxillofacial Pathology Dentistry
57466
CA
1223P0221X
Pediatric Dentistry
57466
CA
1223P0300X
Periodontics
57466
CA
1223P0700X
Prosthodontics
57466
CA
171100000X
Acupuncturist
57466
CA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
57466
CA
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Enumeration date
04/20/2010
Last updated
09/26/2011
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