Provider Demographics
NPI:1841392859
Name:SHAFFER & SHAFFER FAMILY DENTISTRY PSC
Entity Type:Organization
Organization Name:SHAFFER & SHAFFER FAMILY DENTISTRY PSC
Other - Org Name:BARRY C SHAFFER DMD BRUCE W SHAFFER DMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-836-8162
Mailing Address - Street 1:700 SAINT CHRISTOPHER DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101
Mailing Address - Country:US
Mailing Address - Phone:606-836-8162
Mailing Address - Fax:606-836-1387
Practice Address - Street 1:700 SAINT CHRISTOPHER DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101
Practice Address - Country:US
Practice Address - Phone:606-836-8162
Practice Address - Fax:606-836-1387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46351223G0001X
KY46361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty