MEDICARE: MAGGIE SCHAEFER DMD

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	1223G0001X	General Practice Dentistry	019029803	IL

General Provider Information

NPI Number	:	1790191054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGGIE SCHAEFER DMD

Provider Business Mailing Address
First Line	:	2809 MANSION RD
Second Line	:	STE D
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-6724
Country	:	US
Telephone Number	:	217-697-5190
Fax Number	:

Provider Business Practice Location Address
First Line	:	2809 MANSION RD
Second Line	:	STE D
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-6724
Country	:	US
Telephone Number	:	217-697-5190
Fax Number	:

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

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	06/01/2015

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