Provider Demographics
NPI:1972629657
Name:SCHAEFERLE & SCHAEFERLE ADVANCED COSMETIC AND FAMILY DENTAL CARE
Entity type:Organization
Organization Name:SCHAEFERLE & SCHAEFERLE ADVANCED COSMETIC AND FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAEFERLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:614-263-0300
Mailing Address - Street 1:4147 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3001
Mailing Address - Country:US
Mailing Address - Phone:614-263-0300
Mailing Address - Fax:410-263-7914
Practice Address - Street 1:4147 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3001
Practice Address - Country:US
Practice Address - Phone:614-263-0300
Practice Address - Fax:410-263-7914
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
OH21640122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty