Healthcare Provider Details

I. General information

NPI: 1598841587
Provider Name (Legal Business Name): SARAH ILENE SCHAEFFER D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER OF RT N12 &N7 FORT DEFIANCE PHS HOSPITAL
FORT DEFIANCE AZ
86504
US

IV. Provider business mailing address

PO BOX 1056
FORT DEFIANCE AZ
86504-1056
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8885
  • Fax:
Mailing address:
  • Phone: 928-729-2728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21720
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: