1396422531 NPI number — DR. NICHOLAS ALEXANDER SCHUSTER DMD

Table of content: DR. NICHOLAS ALEXANDER SCHUSTER DMD (NPI 1396422531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396422531 NPI number — DR. NICHOLAS ALEXANDER SCHUSTER DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHUSTER
Provider First Name:
NICHOLAS
Provider Middle Name:
ALEXANDER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396422531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1090
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTSVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29551-1090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-857-0111
Provider Business Mailing Address Fax Number:
843-309-8126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARESOUTH CAROLINA, INC.
Provider Second Line Business Practice Location Address:
101 HARRIS ST
Provider Business Practice Location Address City Name:
BISHOPVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
766-815-9845
Provider Business Practice Location Address Fax Number:
800-882-4690
Provider Enumeration Date:
06/29/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  10546 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZX0546 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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