MEDICARE: SCHERTZ DENTAL AND BRACES

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1477390409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCHERTZ DENTAL AND BRACES

Provider Business Mailing Address
First Line	:	3401 FM 3009
Second Line	:
City	:	SCHERTZ
State	:	TX
Zip	:	78154-2711
Country	:	US
Telephone Number	:	210-868-6201
Fax Number	:	210-868-6235

Provider Business Practice Location Address
First Line	:	3401 FM 3009
Second Line	:
City	:	SCHERTZ
State	:	TX
Zip	:	78154-2711
Country	:	US
Telephone Number	:	210-868-6201
Fax Number	:	210-868-6235

Authorized Official
Title or Position	:	REVENUE LEADER
Name	:	BRITTON M THIBODEAUX
Credential	:	RDA
Telephone Number	:	337-573-7021

Provider Enumeration Date	:	07/09/2024
Last Update Date	:	07/09/2024

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1124424734 — MR. ARTHUR LEE CAMPSEY III PA-C
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1801539622 — RICHARD JOSEPH MELLO NP
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Directions to “SCHERTZ DENTAL AND BRACES ” Practice Location

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