Individual
DR. JEFFRY R SHAEFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
188 LONGWOOD AVENUE, HARVARD FACULTY GROUP PRACTICE, BOSTON, MA 02115
(617) 432-3153
(617) 498-1205
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
15402
MA
1223X2210X
Orofacial Pain Dentistry
Primary
15402
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015402
TUFTS HEALTH PLAN
MA
05
—
0282138
—
MA
Enumeration date
12/19/2005
Last updated
10/02/2020
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