=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639179245
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FREDERICA ANN HOFF SCHUSTER D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2005
-----------------------------------------------------
Last Update Date | 02/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 E VERONA AVE
-----------------------------------------------------
City | VERONA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53593-8717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-845-6601
-----------------------------------------------------
Fax | 608-845-1264
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1209 SHOREWOOD BLVD
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53705-2265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-217-6964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 4411-015
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 4411
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------