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General NPI Number Information
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NPI Number | 1780052936
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Entity Type | Individual
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Provider Name | THOMAS J. SCHAFFER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/04/2015
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 326 W 64TH ST
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City | CHICAGO
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State | IL
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Zip | 60621-3146
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Country | US
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Telephone | 773-962-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 1745 PLATT ST
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City | NILES
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State | MI
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Zip | 49120-8733
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Country | US
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Telephone | 718-644-0622
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Fax |
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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 | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 019.034077
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0136
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License Number State | MP
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