MEDICARE: DR. STUART C. SHAFFREN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	033098	NY

General Provider Information

NPI Number	:	1417059981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART C. SHAFFREN D.D.S.

Provider Business Mailing Address
First Line	:	6101 224TH ST
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2331
Country	:	US
Telephone Number	:	718-225-8080
Fax Number	:	718-225-8303

Provider Business Practice Location Address
First Line	:	6101 224TH ST
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2331
Country	:	US
Telephone Number	:	718-225-8080
Fax Number	:	718-225-8303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2006
Last Update Date	:	07/08/2007

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