Provider Demographics
NPI:1730125493
Name:SCHAEFER, KENDRA (DMD)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 RIVER PL
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-4034
Mailing Address - Country:US
Mailing Address - Phone:608-222-6606
Mailing Address - Fax:
Practice Address - Street 1:612 RIVER PL
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-4034
Practice Address - Country:US
Practice Address - Phone:608-222-6606
Practice Address - Fax:608-571-0038
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6509151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
026457Medicare ID - Type Unspecified
U74805Medicare UPIN