Provider Demographics
NPI:1356578421
Name:JOHN M. SHADER DMD, PC
Entity type:Organization
Organization Name:JOHN M. SHADER DMD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:CLARE
Authorized Official - Last Name:SHADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-451-1176
Mailing Address - Street 1:100 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-4135
Mailing Address - Country:US
Mailing Address - Phone:541-451-1176
Mailing Address - Fax:541-451-1424
Practice Address - Street 1:100 E OAK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-4135
Practice Address - Country:US
Practice Address - Phone:541-451-1176
Practice Address - Fax:541-451-1424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD64421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty