Provider Demographics
NPI:1417059981
Name:SHAFFREN, STUART C (DDS)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:C
Last Name:SHAFFREN
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 1:6101 224TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2331
Mailing Address - Country:US
Mailing Address - Phone:718-225-8080
Mailing Address - Fax:718-225-8303
Practice Address - Street 1:6101 224TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2331
Practice Address - Country:US
Practice Address - Phone:718-225-8080
Practice Address - Fax:718-225-8303
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist