MEDICARE: DR. WILLIAM ANDREW SCHACKEL 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DD1148	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	850273952	OTHER	NM	850273952

General Provider Information

NPI Number	:	1477684843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM ANDREW SCHACKEL DDS

Provider Business Mailing Address
First Line	:	2100 CALLE DE LA VUELTA
Second Line	:	B-102
City	:	SANTA FE
State	:	NM
Zip	:	87505
Country	:	US
Telephone Number	:	505-983-5000
Fax Number	:	505-988-1371

Provider Business Practice Location Address
First Line	:	2100 CALLE DE LA VUELTA
Second Line	:	B-102
City	:	SANTA FE
State	:	NM
Zip	:	87501-1933
Country	:	US
Telephone Number	:	505-983-5000
Fax Number	:	505-988-1371

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	10/03/2008

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