Provider Demographics
NPI:1164543831
Name:SCHROEDER, JESSE NATHAN (DDS,MS,PA)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:NATHAN
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:DDS,MS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1948
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034
Mailing Address - Country:US
Mailing Address - Phone:817-514-6253
Mailing Address - Fax:817-514-6230
Practice Address - Street 1:1201 HALL JOHNSON RD
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034
Practice Address - Country:US
Practice Address - Phone:817-514-6253
Practice Address - Fax:817-514-6230
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics