Provider Demographics
NPI:1548771926
Name:JASON SCHROTENBOER DDS MD PC
Entity Type:Organization
Organization Name:JASON SCHROTENBOER DDS MD PC
Other - Org Name:ARBOR VIEW ORAL & FACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHROTENBOER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:773-945-5005
Mailing Address - Street 1:3927 W BELMONT AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5170
Mailing Address - Country:US
Mailing Address - Phone:773-945-5005
Mailing Address - Fax:773-945-5004
Practice Address - Street 1:3927 W BELMONT AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5170
Practice Address - Country:US
Practice Address - Phone:872-239-6787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3190195491223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty