MEDICARE: DR. ULRICH GUENTER SCHOCKELT DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D5558	OR

General Provider Information

NPI Number	:	1003813312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ULRICH GUENTER SCHOCKELT DMD

Provider Business Mailing Address
First Line	:	4150 PACIFIC AVE
Second Line	:	SUITE 200
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2276
Country	:	US
Telephone Number	:	503-357-3121
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 PACIFIC AVE
Second Line	:	SUITE 200
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2276
Country	:	US
Telephone Number	:	503-357-3121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/08/2007

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