Provider Demographics
NPI:1568565745
Name:SCHWAB, JERALD M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERALD
Middle Name:M
Last Name:SCHWAB
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 1:500 N MICHIGAN AVE STE 830
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3752
Mailing Address - Country:US
Mailing Address - Phone:312-642-2299
Mailing Address - Fax:
Practice Address - Street 1:500 N MICHIGAN AVE STE 830
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3752
Practice Address - Country:US
Practice Address - Phone:312-642-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190137621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice