Provider Demographics
NPI:1407045974
Name:SCHELLHASE, KOEHLER, AND O'SHAUGHNESSY, P.A.
Entity type:Organization
Organization Name:SCHELLHASE, KOEHLER, AND O'SHAUGHNESSY, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHELLHASE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:904-388-4600
Mailing Address - Street 1:5435 ORTEGA BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-8435
Mailing Address - Country:US
Mailing Address - Phone:904-388-4600
Mailing Address - Fax:904-389-9499
Practice Address - Street 1:5435 ORTEGA BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-8435
Practice Address - Country:US
Practice Address - Phone:904-388-4600
Practice Address - Fax:904-389-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL61271223X0400X
FLDN163751223X0400X
FLDN168011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty