Provider Demographics
NPI:1750408845
Name:LOMOTAN-SHAEFFER, MARY E (DMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:LOMOTAN-SHAEFFER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:LOMOTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:6100 GREENLAND RD
Mailing Address - Street 2:SUITE #502
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-2453
Mailing Address - Country:US
Mailing Address - Phone:904-723-4407
Mailing Address - Fax:904-723-4406
Practice Address - Street 1:6100 GREENLAND RD
Practice Address - Street 2:SUITE #502
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2453
Practice Address - Country:US
Practice Address - Phone:904-723-4407
Practice Address - Fax:904-723-4406
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL163841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice