Provider Demographics
NPI:1689086217
Name:SCHAFER, ROSS JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:JOHN
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 1:3514 HENNEPIN AVE
Mailing Address - Street 2:APT. 201
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3832
Mailing Address - Country:US
Mailing Address - Phone:574-292-0318
Mailing Address - Fax:
Practice Address - Street 1:1670 BEAM AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1201
Practice Address - Country:US
Practice Address - Phone:651-925-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13375122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist