MEDICARE: DR. WILLIAM KERR SCHUYLER DMD

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	1223P0221X	Pediatric Dentistry	4664	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18313-7	OTHER	OR	DMAP/DHS

General Provider Information

NPI Number	:	1679569313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM KERR SCHUYLER DMD

Provider Business Mailing Address
First Line	:	1741 W HARVARD AVE
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-2716
Country	:	US
Telephone Number	:	541-672-5535
Fax Number	:	541-672-7651

Provider Business Practice Location Address
First Line	:	1741 W HARVARD AVE
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-2716
Country	:	US
Telephone Number	:	541-672-5535
Fax Number	:	541-672-7651

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	06/10/2009

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