MEDICARE: DR. EVAN D SCHAFER DDS

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	3994	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3994	OTHER	WA	WASHINGTON STATE LICENCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205822939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVAN D SCHAFER DDS

Provider Business Mailing Address
First Line	:	4610 N ASH ST
Second Line	:	SUITE 102
City	:	SPOKANE
State	:	WA
Zip	:	99205-1482
Country	:	US
Telephone Number	:	509-328-5721
Fax Number	:	509-328-0936

Provider Business Practice Location Address
First Line	:	4610 N ASH ST
Second Line	:	SUITE 102
City	:	SPOKANE
State	:	WA
Zip	:	99205-1482
Country	:	US
Telephone Number	:	509-328-5721
Fax Number	:	509-328-0936

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	08/30/2007

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