Provider Demographics
NPI:1407622392
Name:SHAFER, ROBERT LANE (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LANE
Last Name:SHAFER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:LANE
Other - Middle Name:
Other - Last Name:SHAFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:3711 MEDICAL DR APT 2736
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2351
Mailing Address - Country:US
Mailing Address - Phone:217-714-8917
Mailing Address - Fax:
Practice Address - Street 1:8210 FLOYD CURL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3923
Practice Address - Country:US
Practice Address - Phone:210-450-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXETN11001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics