Organization
SCHAFFER AND DITTO DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANA HOLMAN (INSURANCE COORDINATOR)
(417) 623-2000
Entity
Organization
Contact information
Practice address
2602 CUNNINGHAM AVE, JOPLIN, MO 64804-1542
(417) 623-2000
(417) 623-7948
Mailing address
2602 CUNNINGHAM AVE, JOPLIN, MO 64804-1542
(417) 623-2000
(417) 623-7948
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
11810
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000020211
MEDICARE PROVIDER #
MO
01
—
000748177
UNITED CONCORDIA PROVIDER #
MO
01
—
29065
BLUE CROSS BLUE SHIELD PROVIDER NUMBER
MO
Enumeration date
03/17/2009
Last updated
03/17/2009
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