MEDICARE: SCOTT VASSEL SCHLOFMAN DDS

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	122300000X	Dentist	31409	TX
2	122300000X	Dentist	D-3906	ID
3	1223E0200X	Endodontics	D-3906	ID
4	1223E0200X	Endodontics	31409	TX

General Provider Information

NPI Number	:	1114901261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT VASSEL SCHLOFMAN DDS

Provider Business Mailing Address
First Line	:	4070 STANLEY RD STE 214
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-2714
Country	:	US
Telephone Number	:	210-295-2368
Fax Number	:

Provider Business Practice Location Address
First Line	:	2940 STANLEY RD
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-2740
Country	:	US
Telephone Number	:	210-295-4095
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	10/16/2023

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