Provider Demographics
NPI:1104965235
Name:SHAFFER, ROBIN D (RDHAP)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:D
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 BLOSSOM CREST ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-9285
Mailing Address - Country:US
Mailing Address - Phone:661-589-0936
Mailing Address - Fax:661-589-0936
Practice Address - Street 1:1717 BLOSSOM CREST ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93314-9285
Practice Address - Country:US
Practice Address - Phone:661-589-0936
Practice Address - Fax:661-589-0936
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH00051-1Medicaid