Healthcare Provider Details

I. General information

NPI: 1437370640
Provider Name (Legal Business Name): WILLIAM THEODORE SCHWARTZ II DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: W THEODORE SCHWARTZ II DDS

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15455 US HIGHWAY 441
EUSTIS FL
32726-8321
US

IV. Provider business mailing address

15455 US HIGHWAY 441
EUSTIS FL
32726-8321
US

V. Phone/Fax

Practice location:
  • Phone: 352-399-0911
  • Fax:
Mailing address:
  • Phone: 352-399-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN5060
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS017117L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberG10000768
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: