Organization
ROBERT W SHAFER DDS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT WILLIAM SHAFER DDS (ORTHODONTIST/OWNER)
(217) 356-9595
Entity
Organization
Contact information
Practice address
2902 CROSSING CT, SUITE A, CHAMPAIGN, IL 61822-6175
(217) 356-9595
(217) 356-6425
Mailing address
2902 CROSSING CT, SUITE A, CHAMPAIGN, IL 61822-6175
(217) 356-9595
(217) 356-6425
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
19022993
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19022993
LICENSE
IL
Enumeration date
09/12/2006
Last updated
06/18/2008
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