Provider Demographics
NPI:1497838809
Name:SCHNEEBERGER, GERALD J (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:J
Last Name:SCHNEEBERGER
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 1:163 SOUTH BELLEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:315-786-3990
Mailing Address - Fax:315-786-3991
Practice Address - Street 1:163 SOUTH BELLEW AVENUE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-786-3990
Practice Address - Fax:315-786-3991
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0421041223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01242171Medicaid
NY54333BMedicare ID - Type Unspecified
U19228Medicare UPIN