Healthcare Provider Details

I. General information

NPI: 1306897830
Provider Name (Legal Business Name): DAVID C SCHAEFER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. ARMY DENTAL ACTIVITY 1631 WETZEL AVE., BLDG. 815
FORT CARSON CO
80913-4040
US

IV. Provider business mailing address

U.S. ARMY DENTAL ACTIVITY 1631 WETZEL AVE., BLDG. 815
FORT CARSON CO
80913-4040
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-5537
  • Fax: 719-526-5551
Mailing address:
  • Phone: 719-526-5537
  • Fax: 719-526-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number11884
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8749
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: