Provider Demographics
NPI:1245250117
Name:SCHAFFNER, RICHARD L (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:SCHAFFNER
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 1:60655 TABLE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92561-3032
Mailing Address - Country:US
Mailing Address - Phone:909-228-9628
Mailing Address - Fax:
Practice Address - Street 1:303 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4607
Practice Address - Country:US
Practice Address - Phone:909-793-8837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA394751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice