Provider Demographics
NPI:1912067596
Name:SCHAFFER, REBECCA SUSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SUSAN
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:SUSAN
Other - Last Name:DORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8046 N 2ND DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5607
Mailing Address - Country:US
Mailing Address - Phone:732-740-7465
Mailing Address - Fax:
Practice Address - Street 1:2620 S 83RD AVE
Practice Address - Street 2:#104
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-7203
Practice Address - Country:US
Practice Address - Phone:623-936-6665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039523-11223G0001X
NJ149221223G0001X
AZD73611223G0001X
AZD073611223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain
No1223G0001XDental ProvidersDentistGeneral Practice