Provider Demographics
NPI:1164892758
Name:DR. CHARLES L. SCHNIBBEN LTD.
Entity Type:Organization
Organization Name:DR. CHARLES L. SCHNIBBEN LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:SCHNIBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-234-6475
Mailing Address - Street 1:1500 LAKELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938
Mailing Address - Country:US
Mailing Address - Phone:217-234-6475
Mailing Address - Fax:
Practice Address - Street 1:1502 LAKELAND BLVD
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938
Practice Address - Country:US
Practice Address - Phone:217-234-6475
Practice Address - Fax:217-235-0282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty