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General NPI Number Information
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NPI Number | 1407045974
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Entity Type | Organization
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Legal Business Name | SCHELLHASE, KOEHLER, AND O'SHAUGHNESSY, P.A.
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 5435 ORTEGA BLVD SUITE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32210-8435
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Country | US
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Telephone | 904-388-4600
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Fax | 904-389-9499
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Provider Business Mailing Address
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Address Line | 5435 ORTEGA BLVD SUITE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32210-8435
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Country | US
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Telephone | 904-388-4600
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Fax | 904-389-9499
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL J SCHELLHASE
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Credential | DDS MS
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Telephone | 904-388-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN16375
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN16801
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 6127
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License Number State | FL
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