Provider Demographics
NPI:1699854968
Name:SCHAEFER, ANN KIMIKO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:KIMIKO
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6053 FRESH POND RD
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-3541
Mailing Address - Country:US
Mailing Address - Phone:718-417-5383
Mailing Address - Fax:
Practice Address - Street 1:6053 FRESH POND RD
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-3541
Practice Address - Country:US
Practice Address - Phone:718-417-5383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0372141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice