MEDICARE: SCHAEFER DENTAL GROUP - GRAND RAPIDS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1174333991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCHAEFER DENTAL GROUP - GRAND RAPIDS, PLLC

Provider Business Mailing Address
First Line	:	4911 W ST JOE HWY
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-4088
Country	:	US
Telephone Number	:	517-321-1848
Fax Number	:	517-321-7757

Provider Business Practice Location Address
First Line	:	657 BALDWIN ST
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-7903
Country	:	US
Telephone Number	:	616-532-3212
Fax Number	:	616-532-3193

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRIAN PATRICK SCHAEFER
Credential	:	DDS
Telephone Number	:	517-896-0039

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/13/2025

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