MEDICARE: SCHUCKIT & OLEJNICZAK ORTHODONTICS, S.C.

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	7185	WI

General Provider Information

NPI Number	:	1528469855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCHUCKIT & OLEJNICZAK ORTHODONTICS, S.C.

Provider Business Mailing Address
First Line	:	101 FALLS RD
Second Line	:	SUITE 504
City	:	GRAFTON
State	:	WI
Zip	:	53024-2612
Country	:	US
Telephone Number	:	262-377-8950
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 FALLS RD
Second Line	:	SUITE 504
City	:	GRAFTON
State	:	WI
Zip	:	53024-2612
Country	:	US
Telephone Number	:	262-377-8950
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. AMANDA OLEJNICZAK
Credential	:	D.D.S., M.S.
Telephone Number	:	262-377-8950

Provider Enumeration Date	:	09/05/2014
Last Update Date	:	09/05/2014

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