Provider Demographics
NPI:1124018106
Name:SCHIERBROCK, THOMAS ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROBERT
Last Name:SCHIERBROCK
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 1:427 E KANESVILLE BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4403
Mailing Address - Country:US
Mailing Address - Phone:712-322-5318
Mailing Address - Fax:712-329-6128
Practice Address - Street 1:427 E KANESVILLE BLVD
Practice Address - Street 2:STE 200
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4403
Practice Address - Country:US
Practice Address - Phone:712-322-5318
Practice Address - Fax:712-329-6128
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA62911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0150821Medicaid