Provider Demographics
NPI:1528125358
Name:SCHAMBACK, AARON MICHEAL (DMD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:MICHEAL
Last Name:SCHAMBACK
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 1:1949 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5535
Mailing Address - Country:US
Mailing Address - Phone:772-398-0990
Mailing Address - Fax:772-398-0939
Practice Address - Street 1:1949 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5535
Practice Address - Country:US
Practice Address - Phone:772-398-0990
Practice Address - Fax:772-398-0939
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN157391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice