Provider Demographics
NPI:1306897830
Name:SCHAEFER, DAVID C (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:U.S. ARMY DENTAL ACTIVITY
Mailing Address - Street 2:1631 WETZEL AVE., BLDG. 815
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4040
Mailing Address - Country:US
Mailing Address - Phone:719-526-5537
Mailing Address - Fax:719-526-5551
Practice Address - Street 1:U.S. ARMY DENTAL ACTIVITY
Practice Address - Street 2:1631 WETZEL AVE., BLDG. 815
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4040
Practice Address - Country:US
Practice Address - Phone:719-526-5537
Practice Address - Fax:719-526-5551
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA118841223X0400X
CO87491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics