Provider Demographics
NPI:1700986395
Name:SHAFFER, BARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BARRY
Other - Middle Name:
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:SUITE 1250
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2124
Mailing Address - Country:US
Mailing Address - Phone:818-789-0555
Mailing Address - Fax:818-789-5011
Practice Address - Street 1:16311 VENTURA BOULEVARD
Practice Address - Street 2:SUITE 1250
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2403
Practice Address - Country:US
Practice Address - Phone:818-789-0555
Practice Address - Fax:818-789-0501
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24177122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist