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NPI 1255595385

NPI 1255595385 : NICKI L SCHAFER DDS : CHANDLER, OK

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General NPI Number Information
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    NPI Number           |    1255595385
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    Entity Type          |    Individual 
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    Provider Name        |    NICKI L SCHAFER DDS
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    07/17/2008
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    Last Update Date     |    07/17/2008
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Provider Practice Location Address
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    Address Line         |    1516 S IOWA 
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    City                 |    CHANDLER
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    State                |    OK
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    Zip                  |    74834
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    Country              |    US
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    Telephone            |    405-258-2684
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    Fax                  |    405-258-5353
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Provider Business Mailing Address
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    Address Line         |    PO BOX 249 
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    City                 |    CHANDLER
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    State                |    OK
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    Zip                  |    74834
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    Country              |    US
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    Telephone            |    405-258-2684
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    Fax                  |    405-258-2684
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    1223G0001X
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    Taxonomy Name        |    General Practice Dentistry
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    License Number       |    6037
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    License Number State |    OK
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