Provider Demographics
NPI:1720129398
Name:SCHAACK FAMILY DENTISTRY, P.C.
Entity type:Organization
Organization Name:SCHAACK FAMILY DENTISTRY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHAACK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-716-5444
Mailing Address - Street 1:6005 S. HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701
Mailing Address - Country:US
Mailing Address - Phone:605-716-5444
Mailing Address - Fax:605-341-0144
Practice Address - Street 1:6005 S. HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-716-5444
Practice Address - Fax:605-341-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM943,M9471223G0001X
SD1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty