Healthcare Provider Details

I. General information

NPI: 1285687541
Provider Name (Legal Business Name): DR. ERIC K SCHALL
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N FRONT ST
ST MARYS OH
45885-2394
US

IV. Provider business mailing address

PO BOX 485
ST MARYS OH
45885-0485
US

V. Phone/Fax

Practice location:
  • Phone: 141-939-4236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30-016159
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: