Provider Demographics
NPI:1306069885
Name:SHAFER, MINDY GAIL (DDS)
Entity type:Individual
Prefix:DR
First Name:MINDY
Middle Name:GAIL
Last Name:SHAFER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5522 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3468
Mailing Address - Country:US
Mailing Address - Phone:954-968-4466
Mailing Address - Fax:954-968-4473
Practice Address - Street 1:5522 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33073-3468
Practice Address - Country:US
Practice Address - Phone:954-968-4466
Practice Address - Fax:954-968-4473
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 13577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist