Provider Demographics
NPI:1164978326
Name:SCHRACK, DONALD THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:THOMAS
Last Name:SCHRACK
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 1:1911 NACHES HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-8657
Mailing Address - Country:US
Mailing Address - Phone:402-661-9764
Mailing Address - Fax:
Practice Address - Street 1:2100 S 14TH ST
Practice Address - Street 2:
Practice Address - City:UNION GAP
Practice Address - State:WA
Practice Address - Zip Code:98903-1252
Practice Address - Country:US
Practice Address - Phone:402-661-9764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000010286122300000X
WADE60752170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist