Provider Demographics
NPI:1538255625
Name:SCHAFFER, PRESTON DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:DAVID
Last Name:SCHAFFER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PRESTON
Other - Middle Name:DAVID
Other - Last Name:SCHAFFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1901 EMMONS AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2700
Mailing Address - Country:US
Mailing Address - Phone:718-646-6600
Mailing Address - Fax:718-646-1993
Practice Address - Street 1:1901 EMMONS AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2700
Practice Address - Country:US
Practice Address - Phone:718-646-6600
Practice Address - Fax:718-646-1993
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0356191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice