Provider Demographics
NPI:1962803429
Name:S. MATT SCHACHT, D.D.S., PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:S. MATT SCHACHT, D.D.S., PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:SCHACHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-450-9515
Mailing Address - Street 1:4600 S SYRACUSE ST STE 900
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2701
Mailing Address - Country:US
Mailing Address - Phone:305-450-9515
Mailing Address - Fax:
Practice Address - Street 1:130 RAMPART WAY STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6443
Practice Address - Country:US
Practice Address - Phone:303-341-7151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2022311223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty