Robert William Shafer, DMD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

19022993 Issued in IL

Practice address

2902 Crossing CT
Suite a
Champaign, IL 61822-6175

Phone

(217) 356-9595

Fax

(217) 356-6425

NPI assigned

Sep 12, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Robert W Shafer DDS LTD

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Champaign, IL
  • NPI 1184728768
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508960170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2902 CROSSING CT",
            "address_2": "SUITE A",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618226175",
            "telephone_number": "217-356-9595",
            "fax_number": "217-356-6425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2902 CROSSING CT",
            "address_2": "SUITE A",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618226175",
            "telephone_number": "217-356-9595",
            "fax_number": "217-356-6425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFER",
        "first_name": "ROBERT",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": "19022993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORTHODONTIC LICENSE",
            "identifier": "19022993",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Christopher Seske, LCPC
• Alicia Severins, LCPC
• Seyedeh Hosna Seyed Reihani
• Natasha J Shadden, BA, MHP, LCPC
• Shae Ellington Counseling
• Shrunjal Manish Shah, M.D.
• Shalom Counseling and Consulting LLC
• Jonathan Shankes
• Sandra Shannon, LCSW
• Sajan Sharma, DPT, PT

• Orthodontics and Dentofacial Orthopedics Dentistry in Champaign, IL
• Providers in Champaign, IL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.