Provider Demographics
NPI:1265443626
Name:SCHAFER, DELP S (DDS)
Entity Type:Individual
Prefix:
First Name:DELP
Middle Name:S
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 1:1525 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-1975
Mailing Address - Country:US
Mailing Address - Phone:262-377-7577
Mailing Address - Fax:262-377-7587
Practice Address - Street 1:1525 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-1975
Practice Address - Country:US
Practice Address - Phone:262-377-7577
Practice Address - Fax:262-377-7587
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5000945G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice