Provider Demographics
NPI:1013028752
Name:SCHAFER, ALAN (DMD MSD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:SCHAFER
Suffix:
Gender:M
Credentials:DMD MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3562
Mailing Address - Country:US
Mailing Address - Phone:970-565-3531
Mailing Address - Fax:970-564-9989
Practice Address - Street 1:101 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3562
Practice Address - Country:US
Practice Address - Phone:970-565-3531
Practice Address - Fax:970-564-9989
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCOLO61441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31771238Medicaid