Provider Demographics
NPI:1033680830
Name:AARON SCHAMBACK, DMD, PA
Entity Type:Organization
Organization Name:AARON SCHAMBACK, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAMBACK
Authorized Official - Suffix:
Authorized Official - Credentials:D
Authorized Official - Phone:772-398-0990
Mailing Address - Street 1:155 SW PORT SAINT LUCIE BLVD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984
Mailing Address - Country:US
Mailing Address - Phone:772-398-0990
Mailing Address - Fax:772-398-0939
Practice Address - Street 1:155 SW PORT SAINT LUCIE BLVD
Practice Address - Street 2:SUITE #101
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984
Practice Address - Country:US
Practice Address - Phone:772-398-0990
Practice Address - Fax:772-398-0939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty