1801295183 NPI number — SCHAEFERLE AND SCHAEFERLE DENTAL CARE, INC

Table of content: DR. DARRYL CHARLES DANIEL WENNER D.O. (NPI 1568757169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801295183 NPI number — SCHAEFERLE AND SCHAEFERLE DENTAL CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHAEFERLE AND SCHAEFERLE DENTAL CARE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801295183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 E FRANKLIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43326-2092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-675-0505
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 E FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43326-2092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-675-0505
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SCHAEFERLE
Authorized Official First Name:
TAMMI
Authorized Official Middle Name:
J
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
419-675-0505

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  21007 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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