1306385034 NPI number — ROBERT K. SCHAFFER DDS INC

Table of content: (NPI 1306385034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306385034 NPI number — ROBERT K. SCHAFFER DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT K. SCHAFFER DDS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SCHAFFER DENTAL EXCELLENCE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306385034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12750 CARMEL COUNTRY RD
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92130-2159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-481-1148
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12750 CARMEL COUNTRY RD
Provider Second Line Business Practice Location Address:
205
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-2159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-481-1148
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SCHAFFER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST/PRESIDENT
Authorized Official Telephone Number:
858-481-1148

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  61261 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 38151 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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