MEDICARE: DR. KRISTINE KAE SCHROCK DDS

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	1223P0700X	Prosthodontics	014522	MO

General Provider Information

NPI Number	:	1134282023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTINE KAE SCHROCK DDS

Provider Business Mailing Address
First Line	:	3906 SHERMAN AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3648
Country	:	US
Telephone Number	:	816-279-5857
Fax Number	:

Provider Business Practice Location Address
First Line	:	3906 SHERMAN AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3648
Country	:	US
Telephone Number	:	816-279-5857
Fax Number	:

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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