Provider Demographics
NPI:1093973331
Name:SCHAACK, JONATHAN PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PETER
Last Name:SCHAACK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 DENTWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8453
Mailing Address - Country:US
Mailing Address - Phone:972-346-4459
Mailing Address - Fax:
Practice Address - Street 1:5971 VIRGINIA PKWY
Practice Address - Street 2:#300
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5539
Practice Address - Country:US
Practice Address - Phone:972-984-7890
Practice Address - Fax:972-984-7680
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry