=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518107663
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN A. SCHACHERL D.D.S.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2009
-----------------------------------------------------
Last Update Date | 03/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 N MAIN ST
-----------------------------------------------------
City | VERONA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53593-1101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-845-6127
-----------------------------------------------------
Fax | 608-845-8082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 N MAIN ST
-----------------------------------------------------
City | VERONA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53593-1101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-845-6127
-----------------------------------------------------
Fax | 608-845-8082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN ALAN SCHACHERL
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 608-845-6127
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 5001623
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------