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General NPI Number Information
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NPI Number | 1184728768
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Entity Type | Organization
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Legal Business Name | ROBERT W SHAFER DDS LTD
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 2902 CROSSING CT SUITE A
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City | CHAMPAIGN
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State | IL
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Zip | 61822-6175
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Country | US
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Telephone | 217-356-9595
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Fax | 217-356-6425
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Provider Business Mailing Address
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Address Line | 2902 CROSSING CT SUITE A
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City | CHAMPAIGN
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State | IL
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Zip | 61822-6175
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Country | US
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Telephone | 217-356-9595
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Fax | 217-356-6425
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Authorized Official
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Title or Position | ORTHODONTIST/OWNER
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Name | ROBERT WILLIAM SHAFER
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Credential | DDS
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Telephone | 217-356-9595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 19022993
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License Number State | IL
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