Provider Demographics
NPI:1598244949
Name:SCHAFER, CRYSTAL ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:ANN
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4396 HICKORY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-5123
Mailing Address - Country:US
Mailing Address - Phone:734-904-1591
Mailing Address - Fax:
Practice Address - Street 1:8339 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-9285
Practice Address - Country:US
Practice Address - Phone:734-847-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010224991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice