Provider Demographics
NPI:1447397765
Name:SCHROEDER, MILES D (DDS)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:D
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 1:8028 E 10TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-5242
Mailing Address - Country:US
Mailing Address - Phone:317-897-8028
Mailing Address - Fax:317-897-8025
Practice Address - Street 1:8028 E 10TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-5242
Practice Address - Country:US
Practice Address - Phone:317-897-8028
Practice Address - Fax:317-897-8025
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN73811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200190760Medicaid