Provider Demographics
NPI:1447455712
Name:MARYBETH D. SHAFFER D.M.D.
Entity type:Organization
Organization Name:MARYBETH D. SHAFFER D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDETN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:330-427-6965
Mailing Address - Street 1:320 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:LEETONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44431-1291
Mailing Address - Country:US
Mailing Address - Phone:330-427-6965
Mailing Address - Fax:330-427-0040
Practice Address - Street 1:320 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:LEETONIA
Practice Address - State:OH
Practice Address - Zip Code:44431-1291
Practice Address - Country:US
Practice Address - Phone:330-427-6965
Practice Address - Fax:330-427-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17171261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental