Provider Demographics
NPI:1417910449
Name:SCHUSTER, DENNIS I (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:I
Last Name:SCHUSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2503
Mailing Address - Country:US
Mailing Address - Phone:817-335-6801
Mailing Address - Fax:817-335-4663
Practice Address - Street 1:747 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2503
Practice Address - Country:US
Practice Address - Phone:817-335-6801
Practice Address - Fax:817-335-4663
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9977208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089538502Medicaid
B88163Medicare UPIN