MEDICARE: DR. ALLEN PHILLIP SCHUSTER D.D.S.

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	1223E0200X	Endodontics	9946	TX

General Provider Information

NPI Number	:	1972508224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLEN PHILLIP SCHUSTER D.D.S.

Provider Business Mailing Address
First Line	:	1112 S LAKE ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4309
Country	:	US
Telephone Number	:	817-338-4444
Fax Number	:	817-338-4461

Provider Business Practice Location Address
First Line	:	1112 S LAKE ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4309
Country	:	US
Telephone Number	:	817-338-4444
Fax Number	:	817-338-4461

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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