Provider Demographics
NPI:1962680207
Name:BRIAN R. SHAFER DDS, P.C.
Entity Type:Organization
Organization Name:BRIAN R. SHAFER DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-262-2739
Mailing Address - Street 1:701 W WATTS ST
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-4458
Mailing Address - Country:US
Mailing Address - Phone:405-262-2739
Mailing Address - Fax:405-262-2905
Practice Address - Street 1:701 W WATTS ST
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-4458
Practice Address - Country:US
Practice Address - Phone:405-262-2739
Practice Address - Fax:405-262-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty