Provider Demographics
NPI:1063500320
Name:SCHAEFER, PETER LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:LYNN
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 BRANDON BLVD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-8224
Mailing Address - Country:US
Mailing Address - Phone:419-975-4016
Mailing Address - Fax:
Practice Address - Street 1:801 BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-8224
Practice Address - Country:US
Practice Address - Phone:419-656-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300188811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice