MEDICARE: CHASE OSHIRO 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	1223G0001X	General Practice Dentistry	6000057-15	WI

General Provider Information

NPI Number	:	1740916527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASE OSHIRO DMD

Provider Business Mailing Address
First Line	:	10 SPRUCEWOOD CT
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-5316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3903 DOUGLAS AVE
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-3230
Country	:	US
Telephone Number	:	262-639-1272
Fax Number	:

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

Provider Enumeration Date	:	07/25/2022
Last Update Date	:	07/25/2022

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