Provider Demographics
NPI:1366772923
Name:SCHROEDER FAMILY DENTISTRY, PC
Entity type:Organization
Organization Name:SCHROEDER FAMILY DENTISTRY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-245-2451
Mailing Address - Street 1:PO BOX J
Mailing Address - Street 2:303 POWELL AVE
Mailing Address - City:COLERAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55722-0810
Mailing Address - Country:US
Mailing Address - Phone:218-245-2451
Mailing Address - Fax:
Practice Address - Street 1:PO BOX J
Practice Address - Street 2:303 POWELL AVE
Practice Address - City:COLERAINE
Practice Address - State:MN
Practice Address - Zip Code:55722-0810
Practice Address - Country:US
Practice Address - Phone:218-245-2451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCHROEDER FAMILY DENTISTRY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12050122300000X
MND11954122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty