Provider Demographics
NPI:1841341146
Name:SHEFFER, PETER C (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:SHEFFER
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 1:510 NORTH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4111
Mailing Address - Country:US
Mailing Address - Phone:413-443-6333
Mailing Address - Fax:
Practice Address - Street 1:510 NORTH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4111
Practice Address - Country:US
Practice Address - Phone:413-443-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA135821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0260797Medicaid