Active NPI
Jonathan Shaffer, DDS
- Dentist
- Fort Sill, OK
National Provider Identifier
1548718018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 31981
- Practice address
- 652 Hamilton Rd.
USA Dental Activity
Fort Sill, OK 73503 - Phone
- (580) 442-3905
- Fax
- (580) 442-4002
- NPI assigned
- Sep 14, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 31981 | TX | Primary |
Addresses
Primary practice location
652 Hamilton Rd.
USA Dental Activity
Fort Sill, OK 73503
Mailing address
652 Hamilton Rd.
USA Dental Activity
Fort Sill, OK 73503
Phone (580) 442-3905
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31981 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473811200000",
"number": "1548718018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "652 HAMILTON RD.",
"address_2": "USA DENTAL ACTIVITY",
"city": "FORT SILL",
"state": "OK",
"postal_code": "73503",
"telephone_number": "580-442-3905",
"fax_number": "580-442-4002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "652 HAMILTON RD.",
"address_2": "USA DENTAL ACTIVITY",
"city": "FORT SILL",
"state": "OK",
"postal_code": "73503",
"telephone_number": "580-442-3905",
"fax_number": "580-442-4002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAFFER",
"first_name": "JONATHAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-09-14",
"last_updated": "2016-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "31981",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Sill, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.