Healthcare Provider Details

I. General information

NPI: 1851446686
Provider Name (Legal Business Name): RANDOLPH ENGEL SCHADER DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 WEST LANCASTER AVE
HAVERFORD PA
19041
US

IV. Provider business mailing address

343 MALIN RD
NEWTOWN SQUARE PA
19073-4318
US

V. Phone/Fax

Practice location:
  • Phone: 610-642-9883
  • Fax:
Mailing address:
  • Phone: 610-642-9882
  • Fax: 610-642-9873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS022303L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: