Provider Demographics
NPI:1477970259
Name:NICKI SCHAFER DDS LLC
Entity Type:Organization
Organization Name:NICKI SCHAFER DDS LLC
Other - Org Name:CHANDLER FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICKI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-258-2684
Mailing Address - Street 1:1516 S IOWA AVE
Mailing Address - Street 2:P O BOX 249
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-9169
Mailing Address - Country:US
Mailing Address - Phone:405-258-2684
Mailing Address - Fax:405-258-5353
Practice Address - Street 1:1516 S IOWA AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-9169
Practice Address - Country:US
Practice Address - Phone:405-258-2684
Practice Address - Fax:405-258-5353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty