Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 23865 | TX |
NPI | 1093973331 |
---|---|
Provider Name | Dr. Jonathan Peter Schaack |
First Address | Prosper, TX 75078-8453 |
Second Address | Mckinney, TX 75071-5539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 16/06/2011 |