Provider Demographics
NPI:1063554830
Name:SCHAEFER, STEPHEN R (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
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 1:2001 S SHIELDS
Mailing Address - Street 2:BLD C
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526
Mailing Address - Country:US
Mailing Address - Phone:970-482-8883
Mailing Address - Fax:970-484-9278
Practice Address - Street 1:2001 S SHIELDS
Practice Address - Street 2:BLD C
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526
Practice Address - Country:US
Practice Address - Phone:970-482-8883
Practice Address - Fax:970-484-9278
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO041901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice