Provider Demographics
NPI:1376990325
Name:SCHARDT ORTHODONTICS
Entity Type:Organization
Organization Name:SCHARDT ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-328-8160
Mailing Address - Street 1:1502 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1747
Mailing Address - Country:US
Mailing Address - Phone:608-328-8160
Mailing Address - Fax:
Practice Address - Street 1:1502 11TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1747
Practice Address - Country:US
Practice Address - Phone:608-328-8160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI64491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty