MEDICARE: CHARLES MICHAEL SCHWACH 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	41504-1	NY

General Provider Information

NPI Number	:	1821284324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES MICHAEL SCHWACH DDS

Provider Business Mailing Address
First Line	:	5432 BROADWAY ST
Second Line	:
City	:	LANCASTER
State	:	NY
Zip	:	14086-2124
Country	:	US
Telephone Number	:	716-683-7313
Fax Number	:

Provider Business Practice Location Address
First Line	:	5432 BROADWAY ST
Second Line	:
City	:	LANCASTER
State	:	NY
Zip	:	14086-2124
Country	:	US
Telephone Number	:	716-683-7313
Fax Number	:	716-683-7358

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

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	01/20/2011

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