Healthcare Provider Details

I. General information

NPI: 1477684843
Provider Name (Legal Business Name): WILLIAM ANDREW SCHACKEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CALLE DE LA VUELTA B-102
SANTA FE NM
87501-1933
US

IV. Provider business mailing address

2100 CALLE DE LA VUELTA B-102
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-5000
  • Fax: 505-988-1371
Mailing address:
  • Phone: 505-983-5000
  • Fax: 505-988-1371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDD1148
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: