Provider Demographics
NPI:1326039942
Name:SCHROEDER, M. LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:M.
Middle Name:LAWRENCE
Last Name:SCHROEDER
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 1:2830 AUTUMN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1145
Mailing Address - Country:US
Mailing Address - Phone:952-448-4116
Mailing Address - Fax:
Practice Address - Street 1:5129 W 98TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-2040
Practice Address - Country:US
Practice Address - Phone:952-835-5082
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN 84031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN71131880Medicaid