Provider Demographics
NPI:1134323983
Name:SHAFFER, GEORGE ELWOOD (DMD,FICD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ELWOOD
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:DMD,FICD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 MAIN ST
Mailing Address - Street 2:#202
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-6430
Mailing Address - Country:US
Mailing Address - Phone:907-225-9439
Mailing Address - Fax:907-247-9430
Practice Address - Street 1:306 MAIN ST
Practice Address - Street 2:#202
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6430
Practice Address - Country:US
Practice Address - Phone:907-225-9439
Practice Address - Fax:907-247-9430
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAS 04661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice