Provider Demographics
NPI:1316064306
Name:SCHACHTEL, BLAIR ADAM (DMD)
Entity type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:ADAM
Last Name:SCHACHTEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 E MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3004
Mailing Address - Country:US
Mailing Address - Phone:973-992-1918
Mailing Address - Fax:973-992-1924
Practice Address - Street 1:66 E MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3004
Practice Address - Country:US
Practice Address - Phone:973-992-1918
Practice Address - Fax:973-992-1924
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 19834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist