Provider Demographics
NPI:1881840320
Name:SCHAEFER, J. WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:WILLIAM
Last Name:SCHAEFER
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 1:901 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-1232
Mailing Address - Country:US
Mailing Address - Phone:618-544-4746
Mailing Address - Fax:618-544-5490
Practice Address - Street 1:901 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-1232
Practice Address - Country:US
Practice Address - Phone:618-544-4746
Practice Address - Fax:618-544-5490
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027770122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist