Provider Demographics
NPI:1477684843
Name:SCHACKEL, WILLIAM ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ANDREW
Last Name:SCHACKEL
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 1:2100 CALLE DE LA VUELTA
Mailing Address - Street 2:B-102
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-983-5000
Mailing Address - Fax:505-988-1371
Practice Address - Street 1:2100 CALLE DE LA VUELTA
Practice Address - Street 2:B-102
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1933
Practice Address - Country:US
Practice Address - Phone:505-983-5000
Practice Address - Fax:505-988-1371
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD11481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM850273952Other850273952