Provider Demographics
NPI:1699884536
Name:SCHAFFER, DENNIS CARL (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:CARL
Last Name:SCHAFFER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 LEITER RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3598
Mailing Address - Country:US
Mailing Address - Phone:937-914-7054
Mailing Address - Fax:937-522-7685
Practice Address - Street 1:405 W GRAND AVE FL 3
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4720
Practice Address - Country:US
Practice Address - Phone:937-723-3368
Practice Address - Fax:937-723-4913
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300147331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0308894Medicaid
OHAS6557473OtherDEA NUMBER
OHAS6557473OtherDEA NUMBER
OH0308894Medicaid