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General NPI Number Information
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NPI Number | 1093973331
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Entity Type | Individual
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Provider Name | JONATHAN PETER SCHAACK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 5971 VIRGINIA PKWY #300
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City | MCKINNEY
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State | TX
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Zip | 75071-5539
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Country | US
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Telephone | 972-984-7890
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Fax | 972-984-7680
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Provider Business Mailing Address
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Address Line | 721 DENTWOOD TRL
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City | PROSPER
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State | TX
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Zip | 75078-8453
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Country | US
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Telephone | 972-346-4459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 23865
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License Number State | TX
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