MEDICARE: JONATHAN P SCHAACK DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1083486591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONATHAN P SCHAACK DDS PLLC

Provider Business Mailing Address
First Line	:	5971 VIRGINIA PKWY STE 300
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-5618
Country	:	US
Telephone Number	:	214-517-2125
Fax Number	:

Provider Business Practice Location Address
First Line	:	5971 VIRGINIA PKWY STE 300
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-5618
Country	:	US
Telephone Number	:	972-984-7890
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PEDIATRIC DENTIST
Name	:	DR. JONATHAN P SCHAACK
Credential	:	DDS
Telephone Number	:	214-517-2125

Provider Enumeration Date	:	10/27/2023
Last Update Date	:	10/27/2023

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