Provider Demographics
NPI:1215938709
Name:SHANTZER, ERIC R
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:R
Last Name:SHANTZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ALMSHOUSE RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1100
Mailing Address - Country:US
Mailing Address - Phone:215-396-9200
Mailing Address - Fax:215-396-9230
Practice Address - Street 1:130 ALMSHOUSE RD
Practice Address - Street 2:SUITE 406
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1100
Practice Address - Country:US
Practice Address - Phone:215-396-9200
Practice Address - Fax:215-396-9230
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022877L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6684910001Medicare NSC