=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184099236
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRISCILA SCHAEFER D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2015
-----------------------------------------------------
Last Update Date | 01/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 ROSS AVE STE 960
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75201-2739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-999-0110
-----------------------------------------------------
Fax | 214-999-0114
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1111 WINDSONG TRL
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75081-4453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-717-7968
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 31500
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------