Provider Demographics
NPI:1841286663
Name:SHADER, JOHN M (DMD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:SHADER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 FIRWOOD CIR SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-5840
Mailing Address - Country:US
Mailing Address - Phone:541-967-7351
Mailing Address - Fax:
Practice Address - Street 1:3830 FIRWOOD CIR SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-5840
Practice Address - Country:US
Practice Address - Phone:541-967-7351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD64421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice