Provider Demographics
NPI:1053424168
Name:SCHUCK, MICHAEL CARLTON (DDS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CARLTON
Last Name:SCHUCK
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 1:10055 N PORTAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2371
Mailing Address - Country:US
Mailing Address - Phone:408-243-7300
Mailing Address - Fax:408-255-4586
Practice Address - Street 1:10055 N PORTAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2371
Practice Address - Country:US
Practice Address - Phone:408-243-7300
Practice Address - Fax:408-255-4586
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist