Provider Demographics
NPI:1548365265
Name:SCHAEFER, BRIAN PATRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PATRICK
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 1:2855 CAROLINA CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-3269
Mailing Address - Country:US
Mailing Address - Phone:920-499-8888
Mailing Address - Fax:920-499-0760
Practice Address - Street 1:2855 CAROLINA CHERRY DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-3269
Practice Address - Country:US
Practice Address - Phone:920-499-8888
Practice Address - Fax:920-499-0760
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3641-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice