MEDICARE: DR. PRISCILA SCHAEFER D.D.S.

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	31500	TX

General Provider Information

NPI Number	:	1184099236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRISCILA SCHAEFER D.D.S.

Provider Business Mailing Address
First Line	:	1111 WINDSONG TRL
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-4453
Country	:	US
Telephone Number	:	734-717-7968
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 ROSS AVE
Second Line	:	STE 960
City	:	DALLAS
State	:	TX
Zip	:	75201-2739
Country	:	US
Telephone Number	:	214-999-0110
Fax Number	:	214-999-0114

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

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	01/05/2016

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