MEDICARE: ERIC R SHANTZER

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	1223G0001X	General Practice Dentistry	DS022877L	PA

General Provider Information

NPI Number	:	1215938709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC R SHANTZER

Provider Business Mailing Address
First Line	:	130 ALMSHOUSE RD
Second Line	:	SUITE 406
City	:	RICHBORO
State	:	PA
Zip	:	18954-1100
Country	:	US
Telephone Number	:	215-396-9200
Fax Number	:	215-396-9230

Provider Business Practice Location Address
First Line	:	130 ALMSHOUSE RD
Second Line	:	SUITE 406
City	:	RICHBORO
State	:	PA
Zip	:	18954-1100
Country	:	US
Telephone Number	:	215-396-9200
Fax Number	:	215-396-9230

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/02/2012

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Directions to “ ERIC R SHANTZER ” Practice Location

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