Provider Demographics
NPI:1871687319
Name:SHAFFER, PATRICK J (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:SHAFFER
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 1:279 ERNEST DR
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 WEST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2296
Practice Address - Country:US
Practice Address - Phone:330-633-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30 . 0150381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice