Provider Demographics
NPI:1851309355
Name:SCHACHT, WALTER E (DMD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:E
Last Name:SCHACHT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 SARDIS GLEN DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-1569
Mailing Address - Country:US
Mailing Address - Phone:704-845-1978
Mailing Address - Fax:
Practice Address - Street 1:2200 THE PLZ
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-3036
Practice Address - Country:US
Practice Address - Phone:704-334-8106
Practice Address - Fax:704-375-2329
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997626Medicaid