MEDICARE: DR JAMES R SCHWARTZ DDS PA

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	9951	MN

General Provider Information

NPI Number	:	1619959426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR JAMES R SCHWARTZ DDS PA

Provider Business Mailing Address
First Line	:	17809 HUTCHINS DR
Second Line	:	SUITE 108
City	:	MINNETONKA
State	:	MN
Zip	:	55345-4100
Country	:	US
Telephone Number	:	952-474-5041
Fax Number	:	952-401-1608

Provider Business Practice Location Address
First Line	:	17809 HUTCHINS DR
Second Line	:	SUITE 108
City	:	MINNETONKA
State	:	MN
Zip	:	55345-4100
Country	:	US
Telephone Number	:	952-474-5041
Fax Number	:	952-401-1608

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES ROSS SCHWARTZ
Credential	:	DENTIST
Telephone Number	:	952-474-5041

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	08/22/2020

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