Provider Demographics
NPI:1073408886
Name:SCHAEFBAUER, NICOLE CAROL MARSHALL (DDS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CAROL MARSHALL
Last Name:SCHAEFBAUER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 WILLMAR AVE SE
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4738
Mailing Address - Country:US
Mailing Address - Phone:320-231-1739
Mailing Address - Fax:
Practice Address - Street 1:1412 WILLMAR AVE SE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4738
Practice Address - Country:US
Practice Address - Phone:320-231-1739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND153191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice