Provider Demographics
NPI:1922109818
Name:SCHAEFER, KATRINA (DMD,MS)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:DMD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 FM 646 RD W STE 205
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-2038
Mailing Address - Country:US
Mailing Address - Phone:281-713-4411
Mailing Address - Fax:
Practice Address - Street 1:1455 FM 646 RD W STE 205
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-2038
Practice Address - Country:US
Practice Address - Phone:281-713-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX295701223E0200X
VA04014115301223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA872859OtherUNITED CONCORDIA