MEDICARE: DR. TIMOTHY E SCHAFER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12009493A	IN

General Provider Information

NPI Number	:	1497778534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY E SCHAFER DDS

Provider Business Mailing Address
First Line	:	1527 N POST RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4213
Country	:	US
Telephone Number	:	317-895-6713
Fax Number	:	317-895-6260

Provider Business Practice Location Address
First Line	:	1527 N POST RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4213
Country	:	US
Telephone Number	:	317-895-6713
Fax Number	:	317-895-6260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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