Provider Demographics
NPI:1700268869
Name:JP SCHAEFFER DENTAL CORPORATION
Entity Type:Organization
Organization Name:JP SCHAEFFER DENTAL CORPORATION
Other - Org Name:MISSION DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHAEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-648-1090
Mailing Address - Street 1:26 S GARDEN ST STE I
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-4524
Mailing Address - Country:US
Mailing Address - Phone:805-648-1090
Mailing Address - Fax:805-641-9130
Practice Address - Street 1:26 S GARDEN ST STE I
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-4524
Practice Address - Country:US
Practice Address - Phone:805-648-1090
Practice Address - Fax:805-641-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA438551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty