=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679654859
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC T SCHIMPFHAUSER D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2006
-----------------------------------------------------
Last Update Date | 05/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8175 KENSINGTON DR #A
-----------------------------------------------------
City | WAXHAW
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28173-0103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-843-3270
-----------------------------------------------------
Fax | 704-843-0412
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8175-A KENSINGTON DR. CURETON TOWN CENTER
-----------------------------------------------------
City | WAXHAW
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-843-3270
-----------------------------------------------------
Fax | 704-843-0412
-----------------------------------------------------
=====================================================
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 | 7029
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------