Healthcare Provider Details

I. General information

NPI: 1306962089
Provider Name (Legal Business Name): SCHAEFERLE & SCHAEFERLE FAMILY DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W MAIN ST
CRESTLINE OH
44827-1378
US

IV. Provider business mailing address

1000 W MAIN ST
CRESTLINE OH
44827-1378
US

V. Phone/Fax

Practice location:
  • Phone: 419-683-1135
  • Fax: 419-683-4252
Mailing address:
  • Phone: 419-683-1135
  • Fax: 419-683-4252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21007
License Number StateOH

VIII. Authorized Official

Name: DR. TAMMI SCHAEFERLE
Title or Position: DENTIST
Credential: DDS
Phone: 419-683-1135