=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275667792
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEPH E SCHARA FAMILY DENTISTRY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 408 SAINT PETER ST SUITE 412
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55102-1130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-224-2011
-----------------------------------------------------
Fax | 651-293-1782
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 408 SAINT PETER ST SUITE 412
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55102-1130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-224-2011
-----------------------------------------------------
Fax | 651-293-1782
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. JOSEPH E SCHARA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 651-224-2011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | D10774
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------