Provider Demographics
NPI:1649649831
Name:SHAER, DAN (MPH, DDS)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:SHAER
Suffix:
Gender:M
Credentials:MPH, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9535 RESEDA BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324
Mailing Address - Country:US
Mailing Address - Phone:818-678-9975
Mailing Address - Fax:
Practice Address - Street 1:9535 RESEDA BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324
Practice Address - Country:US
Practice Address - Phone:818-678-9975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS100673122300000X
ORD10350122300000X
CA1006731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery