Provider Demographics
NPI:1306962089
Name:SCHAEFERLE & SCHAEFERLE FAMILY DENTAL CARE
Entity type:Organization
Organization Name:SCHAEFERLE & SCHAEFERLE FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAEFERLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-683-1135
Mailing Address - Street 1:1000 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-1378
Mailing Address - Country:US
Mailing Address - Phone:419-683-1135
Mailing Address - Fax:419-683-4252
Practice Address - Street 1:1000 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:OH
Practice Address - Zip Code:44827-1378
Practice Address - Country:US
Practice Address - Phone:419-683-1135
Practice Address - Fax:419-683-4252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21007122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty