Provider Demographics
NPI:1699856922
Name:SCHAEFER, DAVID A (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8403 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5501
Mailing Address - Country:US
Mailing Address - Phone:502-423-9555
Mailing Address - Fax:502-694-4470
Practice Address - Street 1:8403 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5501
Practice Address - Country:US
Practice Address - Phone:502-423-5555
Practice Address - Fax:502-423-7701
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY65881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61-1211134OtherTAX ID NUMBER