MEDICARE: DALE RAYMOND SCHUUR 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	122300000X	Dentist	12554	MI

General Provider Information

NPI Number	:	1568685279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE RAYMOND SCHUUR DDS

Provider Business Mailing Address
First Line	:	3250 CENTRAL BLVD
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-1439
Country	:	US
Telephone Number	:	616-669-6600
Fax Number	:	616-669-2964

Provider Business Practice Location Address
First Line	:	3250 CENTRAL BLVD
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-1439
Country	:	US
Telephone Number	:	616-669-6600
Fax Number	:	616-669-2964

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	12/09/2012

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