MEDICARE: SCHARDT ORTHODONTICS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	6449	WI

General Provider Information

NPI Number	:	1376990325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCHARDT ORTHODONTICS

Provider Business Mailing Address
First Line	:	1502 11TH ST
Second Line	:
City	:	MONROE
State	:	WI
Zip	:	53566-1747
Country	:	US
Telephone Number	:	608-328-8160
Fax Number	:

Provider Business Practice Location Address
First Line	:	1502 11TH ST
Second Line	:
City	:	MONROE
State	:	WI
Zip	:	53566-1747
Country	:	US
Telephone Number	:	608-328-8160
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	GREGORY SCHARDT
Credential	:
Telephone Number	:	608-328-8160

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	05/19/2016

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