Healthcare Provider Details

I. General information

NPI: 1043211899
Provider Name (Legal Business Name): DUANE ROBERT SCHAFER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 12TH ST RM 315
RICHMOND VA
23298-5064
US

IV. Provider business mailing address

PO BOX 8887
GREENVILLE TX
75404-8887
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-5687
  • Fax: 804-828-6234
Mailing address:
  • Phone: 254-212-1253
  • Fax: 866-399-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDS0000010158
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDSO23468L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number041412314
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: