MEDICARE: DR. DAVID LEE SCHNECK 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	051970	NY

General Provider Information

NPI Number	:	1316920705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID LEE SCHNECK DDS

Provider Business Mailing Address
First Line	:	US ARMY DENTAL ACTIVITY ATTN CREDENTIALS COORDINATOR
Second Line	:	10205 N RIVA RIDGE LOOP
City	:	FORT DRUM
State	:	NY
Zip	:	13602-5005
Country	:	US
Telephone Number	:	315-772-6234
Fax Number	:	315-774-3558

Provider Business Practice Location Address
First Line	:	US ARMY DENTAL ACTIVITY ATTN CREDENTIALS COORDINATOR
Second Line	:	10205 N RIVA RIDGE LOOP
City	:	FORT DRUM
State	:	NY
Zip	:	13602-5005
Country	:	US
Telephone Number	:	315-772-6234
Fax Number	:	315-774-3558

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	10/06/2010

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