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General NPI Number Information
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NPI Number | 1477970259
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Entity Type | Organization
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Legal Business Name | NICKI SCHAFER DDS LLC
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Dates
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Enumeration Date | 03/18/2014
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Last Update Date | 03/18/2014
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Provider Practice Location Address
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Address Line | 1516 S IOWA AVE
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City | CHANDLER
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State | OK
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Zip | 74834-9169
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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 | 1516 S IOWA AVE P O BOX 249
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City | CHANDLER
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State | OK
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Zip | 74834-9169
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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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Authorized Official
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Title or Position | OWNER
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Name | NICKI LYNN SCHAFER
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Credential | DDS
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Telephone | 405-258-2684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6037
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License Number State | OK
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