Provider Demographics
NPI:1750500963
Name:SCHUMACHER DENTAL CENTER, PA
Entity Type:Organization
Organization Name:SCHUMACHER DENTAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHUMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-388-3559
Mailing Address - Street 1:4201 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2027
Mailing Address - Country:US
Mailing Address - Phone:904-388-3559
Mailing Address - Fax:904-389-8562
Practice Address - Street 1:4201 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2027
Practice Address - Country:US
Practice Address - Phone:904-388-3559
Practice Address - Fax:904-389-8562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1223G0001XOtherDENTIST GENERAL PRACTICE