Provider Demographics
NPI:1033323373
Name:SCHAUB, PHYLLIS MARIE (DDS)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:MARIE
Last Name:SCHAUB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30672 FOX RUN LANE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAP
Mailing Address - State:CA
Mailing Address - Zip Code:92675
Mailing Address - Country:US
Mailing Address - Phone:949-661-3836
Mailing Address - Fax:949-661-3060
Practice Address - Street 1:27871 MEDICAL CENTER ROAD
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-365-0951
Practice Address - Fax:949-365-0327
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA325001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice