Provider Demographics
NPI:1376948414
Name:SCHAFFER, BRIAN DAVID (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:SCHAFFER
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 1:7122 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-7741
Mailing Address - Country:US
Mailing Address - Phone:410-444-6153
Mailing Address - Fax:410-444-6153
Practice Address - Street 1:7122 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-7741
Practice Address - Country:US
Practice Address - Phone:410-444-6153
Practice Address - Fax:410-444-6153
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist