Healthcare Provider Details

I. General information

NPI: 1962680207
Provider Name (Legal Business Name): BRIAN R. SHAFER DDS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W WATTS ST
EL RENO OK
73036-4458
US

IV. Provider business mailing address

701 W WATTS ST
EL RENO OK
73036-4458
US

V. Phone/Fax

Practice location:
  • Phone: 405-262-2739
  • Fax: 405-262-2905
Mailing address:
  • Phone: 405-262-2739
  • Fax: 405-262-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5388
License Number StateOK

VIII. Authorized Official

Name: DR. BRIAN RAY SHAFER
Title or Position: OWNER
Credential: D.D.S.
Phone: 405-262-2739