1639179245 NPI number — FREDERICA ANN HOFF SCHUSTER D.D.S.

Table of content: FREDERICA ANN HOFF SCHUSTER D.D.S. (NPI 1639179245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639179245 NPI number — FREDERICA ANN HOFF SCHUSTER D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHUSTER
Provider First Name:
FREDERICA
Provider Middle Name:
ANN HOFF
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHUSTER
Provider Other First Name:
FREDERICA
Provider Other Middle Name:
HOFF
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1639179245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1209 SHOREWOOD BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53705-2265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-217-6964
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 E VERONA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERONA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53593-8717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-845-6601
Provider Business Practice Location Address Fax Number:
608-845-1264
Provider Enumeration Date:
07/26/2005

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: 1223G0001X , with the licence number:  4411-015 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 4411 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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