Provider Demographics
NPI:1053626986
Name:SHAFER, NOAH MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:NOAH
Middle Name:MICHAEL
Last Name:SHAFER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MONTIANO LOOP SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-8768
Mailing Address - Country:US
Mailing Address - Phone:347-406-2244
Mailing Address - Fax:505-559-4232
Practice Address - Street 1:1500 MONTIANO LOOP SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-8768
Practice Address - Country:US
Practice Address - Phone:347-406-2244
Practice Address - Fax:505-559-4232
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD3321122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist