Healthcare Provider Details

I. General information

NPI: 1982088811
Provider Name (Legal Business Name): JAMES SCHAEFFER PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PARTRIDGE DR STE 210
VENTURA CA
93003-0716
US

IV. Provider business mailing address

1001 PARTRIDGE DR STE 210
VENTURA CA
93003-0716
US

V. Phone/Fax

Practice location:
  • Phone: 805-644-9501
  • Fax: 805-644-1108
Mailing address:
  • Phone: 805-644-9501
  • Fax: 805-644-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43855
License Number StateCA

VIII. Authorized Official

Name: JAMES P SCHAEFFER
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 805-644-9501