Provider Demographics
NPI:1841372109
Name:SCHACHERL, JOHN ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALAN
Last Name:SCHACHERL
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 1:9018 COLBY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-2750
Mailing Address - Country:US
Mailing Address - Phone:608-832-6244
Mailing Address - Fax:
Practice Address - Street 1:105 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1101
Practice Address - Country:US
Practice Address - Phone:608-845-6127
Practice Address - Fax:608-845-8082
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50016231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33552600Medicaid