Provider Demographics
NPI:1255718185
Name:SCHAFER, JILLIAN BLAIR (DMD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:BLAIR
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:JILLIAN
Other - Middle Name:BLAIR
Other - Last Name:FERDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:DENTAL SERVICE 160
Mailing Address - Street 2:1201 BROAD ROCK BLVD.
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23249-0001
Mailing Address - Country:US
Mailing Address - Phone:804-675-5251
Mailing Address - Fax:804-675-5952
Practice Address - Street 1:DENTAL SERVICE 160
Practice Address - Street 2:1201 BROAD ROCK BLVD.
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5251
Practice Address - Fax:804-675-5952
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice