Provider Demographics
NPI:1265087902
Name:SCHAFER, ZEBO (RDH)
Entity type:Individual
Prefix:
First Name:ZEBO
Middle Name:
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11984 RIDGE PKWY APT 208
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-5147
Mailing Address - Country:US
Mailing Address - Phone:609-613-2251
Mailing Address - Fax:
Practice Address - Street 1:877 E SOUTH BOULDER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1345
Practice Address - Country:US
Practice Address - Phone:303-665-8228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLOCAL.0001813124Q00000X
CODH.0020225565124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist