Healthcare Provider Details

I. General information

NPI: 1538259734
Provider Name (Legal Business Name): PAUL VINCENT SCHAUS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3154 VIKING BLVD NW
OAK GROVE MN
55011-9339
US

IV. Provider business mailing address

2816 STEARNS WAY
SAINT CLOUD MN
56303-1373
US

V. Phone/Fax

Practice location:
  • Phone: 763-753-5336
  • Fax:
Mailing address:
  • Phone: 612-916-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12283
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: