Healthcare Provider Details

I. General information

NPI: 1780052936
Provider Name (Legal Business Name): THOMAS J. SCHAFFER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 W 64TH ST
CHICAGO IL
60621-3146
US

IV. Provider business mailing address

1745 PLATT ST
NILES MI
49120-8733
US

V. Phone/Fax

Practice location:
  • Phone: 773-962-3900
  • Fax:
Mailing address:
  • Phone: 718-644-0622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number019.034077
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0136
License Number StateMP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: