Provider Demographics
NPI:1235274077
Name:SCHAFER, DARRELL D (DDS)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:D
Last Name:SCHAFER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S PIONEER WAY
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-2346
Mailing Address - Country:US
Mailing Address - Phone:509-765-5615
Mailing Address - Fax:509-765-7915
Practice Address - Street 1:1100 S PIONEER WAY
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2346
Practice Address - Country:US
Practice Address - Phone:509-765-5615
Practice Address - Fax:509-765-7915
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAD31391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5237904Medicaid